Provider Demographics
NPI:1245426063
Name:MUHAMMAD, JAYVON DUPREE (LM)
Entity Type:Individual
Prefix:MS
First Name:JAYVON
Middle Name:DUPREE
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 YORK ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6253
Mailing Address - Country:US
Mailing Address - Phone:415-583-7436
Mailing Address - Fax:
Practice Address - Street 1:630 DRAKE AVE
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1107
Practice Address - Country:US
Practice Address - Phone:415-583-7436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM197176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife