Healthcare Provider Details

I. General information

NPI: 1619710530
Provider Name (Legal Business Name): CLANCY MCCARTY CNM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 EL CENTRO ST STE 100
SOUTH PASADENA CA
91030-3202
US

IV. Provider business mailing address

1621 SILVERWOOD TER
LOS ANGELES CA
90026-1447
US

V. Phone/Fax

Practice location:
  • Phone: 626-399-0649
  • Fax:
Mailing address:
  • Phone: 310-780-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number95224570
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: