Healthcare Provider Details

I. General information

NPI: 1134048184
Provider Name (Legal Business Name): THE OTHER SIDE OF BIRTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 CANYON VIEW DR
SANTA CLARA UT
84765-5150
US

IV. Provider business mailing address

3169 CANYON VIEW DR
SANTA CLARA UT
84765-5150
US

V. Phone/Fax

Practice location:
  • Phone: 385-444-5267
  • Fax:
Mailing address:
  • Phone: 385-444-5267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: CHLOE GONZALEZ
Title or Position: OWNER
Credential: RN, BSN, IBCLC
Phone: 385-444-5267