Healthcare Provider Details

I. General information

NPI: 1699086538
Provider Name (Legal Business Name): CENTER FOR NATURAL BIRTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 54TH PL
SAN DIEGO CA
92105-2303
US

IV. Provider business mailing address

4135 54TH PLACE
SAN DIEGO CA
92105
US

V. Phone/Fax

Practice location:
  • Phone: 619-814-0567
  • Fax: 619-814-0569
Mailing address:
  • Phone: 619-814-0567
  • Fax: 619-814-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number155
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number162
License Number StateCA

VIII. Authorized Official

Name: MS. GERRI LYNN RYAN
Title or Position: LICENSED MIDWIFE
Credential: LM, CPM
Phone: 619-814-0567