Provider Demographics
NPI:1972123479
Name:BUCKLEY, CINNAMON I (CPM,LM)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:I
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:CPM,LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 E APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3401
Mailing Address - Country:US
Mailing Address - Phone:310-227-1092
Mailing Address - Fax:
Practice Address - Street 1:1028 E APPLETON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3401
Practice Address - Country:US
Practice Address - Phone:310-227-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2022-12-12
Deactivation Date:2022-11-27
Deactivation Code:
Reactivation Date:2022-12-09
Provider Licenses
StateLicense IDTaxonomies
CA694176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife