Healthcare Provider Details

I. General information

NPI: 1851520696
Provider Name (Legal Business Name): CYPRESS AVENUE SAGE FEMMES INC/ CYPRESS AVENUE SAGE FEMMES BIRTH HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 CYPRESS AVE
SOUTH SAN FRANCISCO CA
94080-2861
US

IV. Provider business mailing address

713 CYPRESS AVE
SOUTH SAN FRANCISCO CA
94080-2861
US

V. Phone/Fax

Practice location:
  • Phone: 650-745-8195
  • Fax: 650-989-8408
Mailing address:
  • Phone: 650-745-8195
  • Fax: 650-989-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number91-2166828
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number259079
License Number StateCA

VIII. Authorized Official

Name: JUDITH TINKELENBERG
Title or Position: DIRECTOR/MIDWIFE
Credential:
Phone: 650-745-8195