MEDICARE: LITTLE STAR BIRTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1518847011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE STAR BIRTH SERVICES

Provider Business Mailing Address
First Line	:	4676 LA CUENTA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-3011
Country	:	US
Telephone Number	:	951-347-5418
Fax Number	:	619-374-7180

Provider Business Practice Location Address
First Line	:	4676 LA CUENTA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-3011
Country	:	US
Telephone Number	:	951-347-5418
Fax Number	:	619-374-7180

Authorized Official
Title or Position	:	CEO
Name	:	ANISSA CORNELIUS
Credential	:	LM, CPM, IBCLC
Telephone Number	:	951-347-5418

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	09/04/2025

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Directions to “LITTLE STAR BIRTH SERVICES ” Practice Location

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