Healthcare Provider Details

I. General information

NPI: 1538971619
Provider Name (Legal Business Name): ENVISIONED BIRTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14425 ALMOND ST
CABAZON CA
92230
US

IV. Provider business mailing address

PO BOX 188
CABAZON CA
92230-0188
US

V. Phone/Fax

Practice location:
  • Phone: 951-733-3207
  • Fax:
Mailing address:
  • Phone: 951-733-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DIANA A. PARRA
Title or Position: OPERATIONS MANAGER/OWNER
Credential: CD, HCA
Phone: 951-733-3207