Healthcare Provider Details

I. General information

NPI: 1740711449
Provider Name (Legal Business Name): PURE BIRTHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24355 LYONS AVE STE 240
SANTA CLARITA CA
91321-2390
US

IV. Provider business mailing address

24355 LYONS AVE STE 240
SANTA CLARITA CA
91321-2390
US

V. Phone/Fax

Practice location:
  • Phone: 661-505-8370
  • Fax: 661-206-4408
Mailing address:
  • Phone: 661-505-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberLM409
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberLM409
License Number StateCA

VIII. Authorized Official

Name: MS. TIFFANY GALLO
Title or Position: MIDWIFE, OWNER
Credential: LM, CPM
Phone: 661-505-8370