Healthcare Provider Details

I. General information

NPI: 1184946246
Provider Name (Legal Business Name): JASMINE ALLEGRA MAROTTA-JAENECKE CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 DETROIT ST
SAN FRANCISCO CA
94131-3119
US

IV. Provider business mailing address

400 DETROIT ST
SAN FRANCISCO CA
94131-3119
US

V. Phone/Fax

Practice location:
  • Phone: 650-393-9690
  • Fax:
Mailing address:
  • Phone: 650-393-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10159323
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 60563122
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM243
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM508
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: