Provider Demographics
NPI:1548580947
Name:LYNCH, JILLIAN ANGIER (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:ANGIER
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WORK AVE
Mailing Address - Street 2:
Mailing Address - City:DEL REY OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5534
Mailing Address - Country:US
Mailing Address - Phone:831-620-2768
Mailing Address - Fax:
Practice Address - Street 1:14 WORK AVE
Practice Address - Street 2:
Practice Address - City:DEL REY OAKS
Practice Address - State:CA
Practice Address - Zip Code:93940-5534
Practice Address - Country:US
Practice Address - Phone:831-620-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM363176B00000X
NM09064R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife