Provider Demographics
NPI:1144572264
Name:ETTIEN, A'MAYA (LM)
Entity type:Individual
Prefix:
First Name:A'MAYA
Middle Name:
Last Name:ETTIEN
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 1:435 8TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3964
Mailing Address - Country:US
Mailing Address - Phone:915-497-2530
Mailing Address - Fax:
Practice Address - Street 1:435 8TH ST STE 304
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3964
Practice Address - Country:US
Practice Address - Phone:915-497-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512176B00000X
NM10077R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife