Healthcare Provider Details

I. General information

NPI: 1073223483
Provider Name (Legal Business Name): MOXIE BIRTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 EL CENTRO ST # 100
SOUTH PASADENA CA
91030-3202
US

IV. Provider business mailing address

1416 EL CENTRO ST # 100
SOUTH PASADENA CA
91030-3202
US

V. Phone/Fax

Practice location:
  • Phone: 626-437-7908
  • Fax:
Mailing address:
  • Phone: 626-399-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENTE KAISER
Title or Position: OWNER
Credential: MD
Phone: 213-219-9103