Healthcare Provider Details

I. General information

NPI: 1164722070
Provider Name (Legal Business Name): THE WOMEN'S BIRTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W UNIVERSITY DR
MESA AZ
85201-5627
US

IV. Provider business mailing address

504 W UNIVERSITY DR
MESA AZ
85201-5627
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-6582
  • Fax: 480-890-7467
Mailing address:
  • Phone: 480-833-6582
  • Fax: 480-890-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number13143
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberF0708635
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. CLAUDINE P CALLIGAN
Title or Position: CLINICAL DIRECTOR
Credential: FNP, CNM
Phone: 480-833-6582