Provider Demographics
NPI:1851520696
Name:CYPRESS AVENUE SAGE FEMMES INC/ CYPRESS AVENUE SAGE FEMMES BIRTH HOME
Entity Type:Organization
Organization Name:CYPRESS AVENUE SAGE FEMMES INC/ CYPRESS AVENUE SAGE FEMMES BIRTH HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TINKELENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-745-8195
Mailing Address - Street 1:713 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2861
Mailing Address - Country:US
Mailing Address - Phone:650-745-8195
Mailing Address - Fax:650-989-8408
Practice Address - Street 1:713 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-2861
Practice Address - Country:US
Practice Address - Phone:650-745-8195
Practice Address - Fax:650-989-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91-2166828176B00000X
CA259079261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW538OtherSTATE LICENSE