Provider Demographics
NPI:1891417648
Name:YEARGIN, RAVEN DANIELLE (LM, CPM)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:DANIELLE
Last Name:YEARGIN
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 1:3777 W. FLORIDA AVE.
Mailing Address - Street 2:SUITE #21
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545
Mailing Address - Country:US
Mailing Address - Phone:909-834-7353
Mailing Address - Fax:
Practice Address - Street 1:42585 GIBBEL RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-9255
Practice Address - Country:US
Practice Address - Phone:909-834-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CA699176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula