Provider Demographics
NPI:1255666558
Name:CREATIVE BIRTH LLC
Entity Type:Organization
Organization Name:CREATIVE BIRTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DIGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-456-4888
Mailing Address - Street 1:3001 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:200
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5155
Mailing Address - Country:US
Mailing Address - Phone:954-456-4888
Mailing Address - Fax:954-456-9721
Practice Address - Street 1:3001 W HALLANDALE BEACH BLVD
Practice Address - Street 2:200
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5155
Practice Address - Country:US
Practice Address - Phone:954-456-4888
Practice Address - Fax:954-456-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty