1447397203 NPI number — BEACH CITIES MIDWIFERY & WOMEN'S HEALTH

Table of content: (NPI 1447397203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447397203 NPI number — BEACH CITIES MIDWIFERY & WOMEN'S HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEACH CITIES MIDWIFERY & WOMEN'S HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447397203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
665 CAMINO DE LOS MARES STE 203A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN CLEMENTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92673-2836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-661-3101
Provider Business Mailing Address Fax Number:
949-443-5275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
665 CAMINO DE LOS MARES STE 203A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN CLEMENTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92673-2836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-661-3101
Provider Business Practice Location Address Fax Number:
949-443-5275
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHERWOOD
Authorized Official First Name:
LISA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
CERTIFIED NURSE MIDWIFE
Authorized Official Telephone Number:
949-661-3101

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  301031 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 301031 . This is a "CALIFORNIA LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1430 . This is a "MF, NMW" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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