Healthcare Provider Details

I. General information

NPI: 1386561991
Provider Name (Legal Business Name): OM WOMEN'S HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 WILSHIRE BLVD STE 600
LOS ANGELES CA
90025-1776
US

IV. Provider business mailing address

1418 10TH ST APT 7
SANTA MONICA CA
90401-2811
US

V. Phone/Fax

Practice location:
  • Phone: 310-922-6883
  • Fax:
Mailing address:
  • Phone: 310-922-6883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIA PASTOR KNOLL
Title or Position: OWNER/CHIEF EXECUTIVE OFFICER
Credential: CNM, APRN
Phone: 310-922-6883