Provider Demographics
NPI:1215965827
Name:REAGAN, ABIGAIL (LM)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 E GREEN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2417
Mailing Address - Country:US
Mailing Address - Phone:415-922-1221
Mailing Address - Fax:
Practice Address - Street 1:1041 E GREEN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2417
Practice Address - Country:US
Practice Address - Phone:415-922-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife