Provider Demographics
NPI:1447806245
Name:NATURAL BIRTH PLACE PROVIDERS A PROFESSIONAL NURSE MIDWIFERY CORP.
Entity Type:Organization
Organization Name:NATURAL BIRTH PLACE PROVIDERS A PROFESSIONAL NURSE MIDWIFERY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:714-470-1506
Mailing Address - Street 1:6240 BLACK PEARL CT
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-4405
Mailing Address - Country:US
Mailing Address - Phone:714-470-1506
Mailing Address - Fax:
Practice Address - Street 1:1881 BUSINESS CENTER DR STE 8A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3448
Practice Address - Country:US
Practice Address - Phone:844-452-0385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-RiskGroup - Single Specialty
No163WP1700XNursing Service ProvidersRegistered NursePerinatalGroup - Single Specialty
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12646542OtherCAQH PROVIDER ID