Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 580 | CA |
NPI | 1023667193 |
---|---|
Provider Name | Mireille Gayle Cervelli |
First Address | Santa Cruz, CA 95062-2212 |
Second Address | Santa Cruz, CA 95060-3614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2019 |
Last Update Date | 10/09/2019 |