Healthcare Provider Details

I. General information

NPI: 1831472992
Provider Name (Legal Business Name): SACRED PASSAGE MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NE 44TH ST
MIAMI FL
33137-3413
US

IV. Provider business mailing address

57 NE 44TH ST
MIAMI FL
33137-3413
US

V. Phone/Fax

Practice location:
  • Phone: 305-340-1189
  • Fax:
Mailing address:
  • Phone: 305-340-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number246
License Number StateFL

VIII. Authorized Official

Name: LAMITSOI KHAILYLAH JORDAN
Title or Position: OWNER/MIDWIFE
Credential: LM
Phone: 305-340-1189