Healthcare Provider Details

I. General information

NPI: 1982585469
Provider Name (Legal Business Name): DESERT BLOOM BIRTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N GREENFIELD RD STE 101
GILBERT AZ
85234-5044
US

IV. Provider business mailing address

875 N GREENFIELD RD STE 101
GILBERT AZ
85234-5044
US

V. Phone/Fax

Practice location:
  • Phone: 480-664-7463
  • Fax: 480-612-0116
Mailing address:
  • Phone: 480-664-7463
  • Fax: 480-612-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELISSA PETERIS
Title or Position: OWNER
Credential: CPM
Phone: 602-228-9235