Healthcare Provider Details

I. General information

NPI: 1033705397
Provider Name (Legal Business Name): CHAI MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 CR B36
RIBERA NM
87560
US

IV. Provider business mailing address

HC 72 BOX 18
RIBERA NM
87560-9601
US

V. Phone/Fax

Practice location:
  • Phone: 206-719-1959
  • Fax:
Mailing address:
  • Phone: 206-719-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: SORAYA SHAH
Title or Position: OWNER
Credential: CPM, LM
Phone: 206-719-1959