Healthcare Provider Details

I. General information

NPI: 1902727902
Provider Name (Legal Business Name): WILLOW BIRTH VILLAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 MESA VERDE DR E STE 210
COSTA MESA CA
92626-5219
US

IV. Provider business mailing address

633B PULLER PL
SAN CLEMENTE CA
92672-2560
US

V. Phone/Fax

Practice location:
  • Phone: 949-689-6706
  • Fax:
Mailing address:
  • Phone: 949-689-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MRS. CODI CHRISTINA ALLRED
Title or Position: OWNER/BIRTH DOULA
Credential: CD
Phone: 949-689-6706