Healthcare Provider Details

I. General information

NPI: 1679507008
Provider Name (Legal Business Name): DEENA LAKSHMI MALLAREDDY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST STE 508
SAN FRANCISCO CA
94110-4423
US

IV. Provider business mailing address

PO BOX 60000 FILE 74175
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-2140
  • Fax: 415-641-2150
Mailing address:
  • Phone: 415-641-2177
  • Fax: 415-641-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW1429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: