Provider Demographics
NPI:1396124954
Name:MULDER, DEANNA MICHELLE (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MICHELLE
Last Name:MULDER
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 1:789 ESTUDILLO AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577
Mailing Address - Country:US
Mailing Address - Phone:510-421-6180
Mailing Address - Fax:
Practice Address - Street 1:789 ESTUDILLO AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5109
Practice Address - Country:US
Practice Address - Phone:510-421-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM439176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALM439OtherMEDICAL BOARD OF CALIFORNIA