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NPI Code Detail

MEDICARE: ANDALUZ BIRTH CENTER

MEDICARE: ANDALUZ BIRTH CENTER
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
1176B00000XMidwifeDEM-LD-1000044OR

General Provider Information

NPI Number : 1922440775
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANDALUZ BIRTH CENTER
Provider Business Mailing Address
First Line : 3323 SW NAITO PKWY
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4672
Country : US
Telephone Number : 503-885-0228
Fax Number :
Provider Business Practice Location Address
First Line : 3323 SW NAITO PKWY
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4672
Country : US
Telephone Number : 503-885-0228
Fax Number :
Authorized Official
Title or Position : OWNER / PRACTICE MANAGER
Name : JENNIFER S GALLARDO
Credential : CPM LDM
Telephone Number : 503-885-0228
Provider Enumeration Date : 07/22/2013
Last Update Date : 07/22/2013

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