Healthcare Provider Details

I. General information

NPI: 1114396298
Provider Name (Legal Business Name): PUSH MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ROLLING OAKS DR SUITE 190
THOUSAND OAKS CA
91361-1029
US

IV. Provider business mailing address

415 ROLLING OAKS DR SUITE 190
THOUSAND OAKS CA
91361-1029
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-1333
  • Fax: 805-494-1555
Mailing address:
  • Phone: 805-494-1333
  • Fax: 805-494-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM 350
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberLM 350
License Number StateCA

VIII. Authorized Official

Name: MRS. ROBYN POOL
Title or Position: OWNER /LICENSED MIDWIFE
Credential: LM, CPM
Phone: 805-494-1333