Healthcare Provider Details

I. General information

NPI: 1396580999
Provider Name (Legal Business Name): INNA DAGMAN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 07/22/2025
Certification Date: 06/26/2024
Deactivation Date: 06/03/2025
Reactivation Date: 07/22/2025

III. Provider practice location address

320 RIVER ST
SANTA CRUZ CA
95060-2723
US

IV. Provider business mailing address

2317 VINE HILL RD
SANTA CRUZ CA
95065-9508
US

V. Phone/Fax

Practice location:
  • Phone: 415-672-4259
  • Fax:
Mailing address:
  • Phone: 415-672-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: