Healthcare Provider Details

I. General information

NPI: 1174390686
Provider Name (Legal Business Name): SOUTHERN ARIZONA BIRTH SUPPORT FUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 N ORACLE RD
TUCSON AZ
85704-4224
US

IV. Provider business mailing address

3408 W WING TIP DR
MARANA AZ
85658-4690
US

V. Phone/Fax

Practice location:
  • Phone: 520-505-1895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: LORIE MICHAELS
Title or Position: DIRECTOR
Credential:
Phone: 520-505-1895