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General NPI Number Information
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NPI Number | 1427418425
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Entity Type | Organization
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Legal Business Name | MAGNOLIA BIRTH HOUSE
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 16821 NE 6TH AVE
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2405
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Country | US
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Telephone | 786-953-6534
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Fax | 786-250-1938
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Provider Business Mailing Address
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Address Line | 16821 NE 6TH AVE
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2405
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Country | US
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Telephone | 786-953-6534
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Fax | 786-250-1938
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMARA TAITT
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Credential |
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Telephone | 786-953-6534
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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 | 358
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License Number State | FL
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