Healthcare Provider Details

I. General information

NPI: 1225703663
Provider Name (Legal Business Name): KINDREDSPACELA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 SOUTHWEST DR
LOS ANGELES CA
90043-4528
US

IV. Provider business mailing address

2610 SOUTHWEST DR
LOS ANGELES CA
90043-4528
US

V. Phone/Fax

Practice location:
  • Phone: 323-381-5511
  • Fax:
Mailing address:
  • Phone: 323-381-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ANN DURDIN
Title or Position: CO-DIRECTOR/MIDWIFE
Credential: LM,CPM
Phone: 310-986-4996