Individual
MRS. EMILY RUTH DECKENBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM CPM
Contact information
Practice address
917 GREEN AVE, SAN BRUNO, CA 94066-3131
(415) 649-6262
Mailing address
PO BOX 395, SAN BRUNO, CA 94066-0395
(415) 649-6262
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
438
CA
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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