Healthcare Provider Details

I. General information

NPI: 1790640936
Provider Name (Legal Business Name): MATERNAL HEALTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8690 AERO DR
SAN DIEGO CA
92123-1886
US

IV. Provider business mailing address

1125 E BROADWAY # 2242
GLENDALE CA
91205-1315
US

V. Phone/Fax

Practice location:
  • Phone: 619-608-1488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JADE STORMS
Title or Position: BOARD MEMBER
Credential:
Phone: 310-403-4886