Healthcare Provider Details

I. General information

NPI: 1710708474
Provider Name (Legal Business Name): LA MATRIZ BIRTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 CAMINO DEL RIO SOUTH STE 206
SAN DIEGO CA
92108
US

IV. Provider business mailing address

6752 HIBISCUS DR
LEMON GROVE CA
91945-1316
US

V. Phone/Fax

Practice location:
  • Phone: 408-209-2234
  • Fax: 619-761-5825
Mailing address:
  • Phone: 408-209-2223
  • Fax: 619-761-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: BIANCA V MERCADO
Title or Position: LICENSED MIDWIFE
Credential: LM
Phone: 408-209-2234