MEDICARE: SARA SHIRRELL GOTTLIEB LM, CPM, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	385	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LICENSED MIDWIFE 385	OTHER	CA	CALIFORNIA

General Provider Information

NPI Number	:	1477974822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA SHIRRELL GOTTLIEB LM, CPM, IBCLC

Provider Business Mailing Address
First Line	:	645 MAGNOLIA AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-3621
Country	:	US
Telephone Number	:	818-625-1574
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 MAGNOLIA AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-3621
Country	:	US
Telephone Number	:	818-625-1574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2014
Last Update Date	:	04/16/2026

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