Healthcare Provider Details

I. General information

NPI: 1588716930
Provider Name (Legal Business Name): ILENE A GELBAUM CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N LAKEVIEW AVE
ANAHEIM CA
92807-3028
US

IV. Provider business mailing address

441 N LAKEVIEW AVE
ANAHEIM CA
92807-3028
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-2800
  • Fax:
Mailing address:
  • Phone: 888-988-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: