Provider Demographics
NPI:1003205881
Name:BEACH SIDE BIRTH CENTER CORONA
Entity Type:Organization
Organization Name:BEACH SIDE BIRTH CENTER CORONA
Other - Org Name:BEACH SIDE BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE AND BILLING MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-215-7575
Mailing Address - Street 1:24902 MOULTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-6403
Mailing Address - Country:US
Mailing Address - Phone:949-215-7575
Mailing Address - Fax:949-215-5757
Practice Address - Street 1:1353 OLD TEMESCAL RD
Practice Address - Street 2:103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7262
Practice Address - Country:US
Practice Address - Phone:949-215-7575
Practice Address - Fax:949-215-5757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACH CITIES MIDWIFERY & WOMEN'S HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing