Provider Demographics
NPI:1134890080
Name:IRAHETA, SANDRA IVONNE (CPM, LM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:IVONNE
Last Name:IRAHETA
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 1:211 W PEDREGOSA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2826
Mailing Address - Country:US
Mailing Address - Phone:805-570-4442
Mailing Address - Fax:
Practice Address - Street 1:211 W PEDREGOSA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2826
Practice Address - Country:US
Practice Address - Phone:805-570-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty