Provider Demographics
NPI:1588024244
Name:PAGLE, JINNY LEE (LM, CPM, CD)
Entity Type:Individual
Prefix:
First Name:JINNY
Middle Name:LEE
Last Name:PAGLE
Suffix:
Gender:F
Credentials:LM, CPM, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1862
Mailing Address - Country:US
Mailing Address - Phone:415-238-6887
Mailing Address - Fax:
Practice Address - Street 1:3919 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-1862
Practice Address - Country:US
Practice Address - Phone:415-238-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA680367A00000X, 176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374J00000XNursing Service Related ProvidersDoula