Provider Demographics
NPI:1184810236
Name:HAAG, CINDY LARA (LM, CPM)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LARA
Last Name:HAAG
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 1:3024 FULTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1845
Mailing Address - Country:US
Mailing Address - Phone:510-704-8366
Mailing Address - Fax:
Practice Address - Street 1:3101 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1984
Practice Address - Country:US
Practice Address - Phone:510-725-8234
Practice Address - Fax:510-255-2058
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QB0400X
CALM132176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing