Healthcare Provider Details

I. General information

NPI: 1538592472
Provider Name (Legal Business Name): BIRTH YOUR WAY BIRTH CENTER - AN INTERNATIONAL MIDWIFERY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12152 BRYANT ST
YUCAIPA CA
92399-4478
US

IV. Provider business mailing address

12152 BRYANT ST PO BOX 942
YUCAIPA CA
92399-4478
US

V. Phone/Fax

Practice location:
  • Phone: 951-263-9666
  • Fax: 909-797-6849
Mailing address:
  • Phone: 951-263-9666
  • Fax: 909-797-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number1593
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number1593
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIA ANGELA KING
Title or Position: ADVANCED PRACTICE MIDWIFE
Credential: CNM
Phone: 951-263-9666