Healthcare Provider Details

I. General information

NPI: 1306128400
Provider Name (Legal Business Name): DELLAREECE CATHERINE BASTIAN MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 NW 173RD TER
MIAMI FL
33169-5120
US

IV. Provider business mailing address

1471 NW 173RD TER
MIAMI FL
33169-5120
US

V. Phone/Fax

Practice location:
  • Phone: 786-431-8121
  • Fax:
Mailing address:
  • Phone: 786-431-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: