Healthcare Provider Details

I. General information

NPI: 1770880429
Provider Name (Legal Business Name): CENTER FOR BIRTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EASTLAKE AVE E 1500 EASTLAKE AVE E
SEATTLE WA
98102-3707
US

IV. Provider business mailing address

1500 EASTLAKE AVE E 1500 EASTLAKE AVE E
SEATTLE WA
98102-3707
US

V. Phone/Fax

Practice location:
  • Phone: 206-407-3397
  • Fax: 206-407-3775
Mailing address:
  • Phone: 206-407-3397
  • Fax: 206-407-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberCBC FS 60203814
License Number StateWA

VIII. Authorized Official

Name: MS. TINA TSIAKALIS
Title or Position: MANAGER, DIRECTOR
Credential: LM, CPM
Phone: 206-369-5315