MEDICARE: SAN DIEGO COUNTY MIDWIVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	LM 162 & LM 297	CA

General Provider Information

NPI Number	:	1619327137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO COUNTY MIDWIVES

Provider Business Mailing Address
First Line	:	275 S WORTHINGTON ST SPC 120
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-6344
Country	:	US
Telephone Number	:	619-434-9011
Fax Number	:	619-434-9199

Provider Business Practice Location Address
First Line	:	15644 POMERADO RD STE 302
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2455
Country	:	US
Telephone Number	:	858-278-2930
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. GERRI LYNN RYAN
Credential	:	LM, CPM
Telephone Number	:	619-957-0910

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	09/26/2019

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Directions to “SAN DIEGO COUNTY MIDWIVES ” Practice Location

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