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General NPI Number Information
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NPI Number | 1063713477
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Entity Type | Organization
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Legal Business Name | SANTA LUCIA BIRTH CENTER, INC.
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 4251 S HIGUERA ST SUITE 300
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7700
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Country | US
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Telephone | 805-548-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 4251 S HIGUERA ST SUITE 300
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7700
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Country | US
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Telephone | 805-548-0606
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TIFFANY LEE DIETRICH
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Credential | ND, LM
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Telephone | 805-548-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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