Healthcare Provider Details

I. General information

NPI: 1447397203
Provider Name (Legal Business Name): BEACH CITIES MIDWIFERY & WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CAMINO DE LOS MARES STE 203A
SAN CLEMENTE CA
92673-2836
US

IV. Provider business mailing address

665 CAMINO DE LOS MARES STE 203A
SAN CLEMENTE CA
92673-2836
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-3101
  • Fax: 949-443-5275
Mailing address:
  • Phone: 949-661-3101
  • Fax: 949-443-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number301031
License Number StateCA

VIII. Authorized Official

Name: MRS. LISA B. SHERWOOD
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: CNM, WHCNP, RN
Phone: 949-661-3101