Healthcare Provider Details

I. General information

NPI: 1588011589
Provider Name (Legal Business Name): THE NATURAL BIRTH PLACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 BUSINESS CENTER DR SUITE 8A
SAN BERNARDINO CA
92408-3465
US

IV. Provider business mailing address

1881 BUSINESS CENTER DR SUITE 8A
SAN BERNARDINO CA
92408-3465
US

V. Phone/Fax

Practice location:
  • Phone: 184-452-0385
  • Fax:
Mailing address:
  • Phone: 184-452-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA ANGELA KING
Title or Position: OWNER
Credential: CNM
Phone: 909-567-2165