Healthcare Provider Details

I. General information

NPI: 1023106622
Provider Name (Legal Business Name): JUDITH IRENE TINKELENBERG RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 W LAS POSITAS BLVD STE 100
PLEASANTON CA
94588
US

IV. Provider business mailing address

4361 RAILROAD AVE STE H
PLEASANTON CA
94566-6611
US

V. Phone/Fax

Practice location:
  • Phone: 925-462-1755
  • Fax:
Mailing address:
  • Phone: 925-462-1755
  • Fax: 925-462-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: