Healthcare Provider Details

I. General information

NPI: 1750751905
Provider Name (Legal Business Name): SARA MARIE FORREST JAIMES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 02/11/2022
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

500B JEFFERSON BLVD
WEST SACRAMENTO CA
95605-2349
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5311
  • Fax:
Mailing address:
  • Phone: 916-403-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP7426
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM236114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: