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General NPI Number Information
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NPI Number | 1487064325
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Entity Type | Organization
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Legal Business Name | FAMILY CENTERED BIRTH
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 17399 HEIGHTS LN
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City | RIVERSIDE
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State | CA
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Zip | 92503-7092
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Country | US
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Telephone | 714-812-5275
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Fax | 208-979-5283
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Provider Business Mailing Address
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Address Line | 1820 FULLERTON AVE STE 250
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City | CORONA
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State | CA
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Zip | 92881-7001
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Country | US
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Telephone | 714-812-5275
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Fax | 208-979-5283
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Authorized Official
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Title or Position | LICENSED MIDWIFE
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Name | MRS. KATHARINE E POTTHAST
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Credential | LM, CPM
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Telephone | 714-812-5275
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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 | LM347
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License Number State | CA
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