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General NPI Number Information
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NPI Number | 1619710530
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Entity Type | Individual
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Provider Name | CLANCY MCCARTY CNM, RN
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Gender | Female
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 1416 EL CENTRO ST STE 100
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3202
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Country | US
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Telephone | 626-399-0649
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Fax |
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Provider Business Mailing Address
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Address Line | 1621 SILVERWOOD TER
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City | LOS ANGELES
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State | CA
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Zip | 90026-1447
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Country | US
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Telephone | 310-780-1094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0102X
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Taxonomy Name | Maternal Newborn Registered Nurse
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License Number | 95224570
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 236456
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License Number State | CA
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