Healthcare Provider Details

I. General information

NPI: 1255666558
Provider Name (Legal Business Name): CREATIVE BIRTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W HALLANDALE BEACH BLVD 200
HALLANDALE FL
33009-5155
US

IV. Provider business mailing address

3001 W HALLANDALE BEACH BLVD 200
HALLANDALE FL
33009-5155
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-4888
  • Fax: 954-456-9721
Mailing address:
  • Phone: 954-456-4888
  • Fax: 954-456-9721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. WAYNE P DIGIACOMO
Title or Position: DIRECTOR/OWNER
Credential: M.D.
Phone: 954-456-4888