Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM662 | CA |
NPI | 1104586700 |
---|---|
Provider Name | Mrs. Emma Belle Moreland |
First Address | Chula Vista, CA 91910-6471 |
Second Address | San Diego, CA 92108-4014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2021 |
Last Update Date | 22/12/2021 |