Individual
MARY BETH CANAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1030 INTERNATIONAL BLVD, OAKLAND, CA 94606-3730
(510) 238-5400
(510) 238-5437
Mailing address
1601 FRUITVALE AVE, OAKLAND, CA 94601-2322
(510) 535-4000
(510) 535-4128
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
NMW1440
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-1822
FQHC MEDICARE PART A
CA
05
—
FHC11991F
—
CA
01
—
HAP11991F
FPACT
CA
01
—
ZZZ79046Z
FQHC MEDICARE PART B
CA
Enumeration date
09/25/2006
Last updated
08/03/2010
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