Provider Demographics
NPI:1205514411
Name:SAGEFEMME WELLNESS LLC
Entity type:Organization
Organization Name:SAGEFEMME WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYDIA-CARLIE
Authorized Official - Middle Name:BLAIN
Authorized Official - Last Name:TILUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-260-3691
Mailing Address - Street 1:400 E HILLSDALE BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2882
Mailing Address - Country:US
Mailing Address - Phone:909-758-6248
Mailing Address - Fax:
Practice Address - Street 1:225 CABRILLO HWY S STE 204C
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1738
Practice Address - Country:US
Practice Address - Phone:424-260-3691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty