Provider Demographics
NPI:1093916694
Name:SACRED ENTRANCE MIDWIFERY SERVICES
Entity Type:Organization
Organization Name:SACRED ENTRANCE MIDWIFERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANGUEULIDI
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:310-566-7690
Mailing Address - Street 1:11965 VENICE BLVD
Mailing Address - Street 2:SUITE# 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3979
Mailing Address - Country:US
Mailing Address - Phone:310-566-7690
Mailing Address - Fax:310-566-7699
Practice Address - Street 1:11965 VENICE BLVD
Practice Address - Street 2:SUITE# 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3979
Practice Address - Country:US
Practice Address - Phone:310-566-7690
Practice Address - Fax:310-566-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty