Provider Demographics
NPI:1023667193
Name:CERVELLI, MIREILLE GAYLE (LM, CPM)
Entity type:Individual
Prefix:
First Name:MIREILLE
Middle Name:GAYLE
Last Name:CERVELLI
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 1:101 HAGEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2212
Mailing Address - Country:US
Mailing Address - Phone:831-566-1167
Mailing Address - Fax:
Practice Address - Street 1:701 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3614
Practice Address - Country:US
Practice Address - Phone:831-566-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA580176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife