Healthcare Provider Details

I. General information

NPI: 1528896578
Provider Name (Legal Business Name): BRILLIANT BIRTHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 4TH ST STE D
BERKELEY CA
94710-1950
US

IV. Provider business mailing address

1411 ARLINGTON BLVD
EL CERRITO CA
94530-2001
US

V. Phone/Fax

Practice location:
  • Phone: 510-214-6251
  • Fax:
Mailing address:
  • Phone: 510-384-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEIDI MARIE KATE
Title or Position: OWNER
Credential: CHILDBIRTH EDUCATOR
Phone: 510-384-5575