Provider Demographics
NPI:1609871243
Name:SOUTH COAST MIDWIFERY & WOMEN'S HEALTH CARE
Entity Type:Organization
Organization Name:SOUTH COAST MIDWIFERY & WOMEN'S HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, NP, CNM
Authorized Official - Phone:949-654-2727
Mailing Address - Street 1:4650 BARRANCA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4733
Mailing Address - Country:US
Mailing Address - Phone:949-654-2727
Mailing Address - Fax:949-654-2735
Practice Address - Street 1:4650 BARRANCA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4733
Practice Address - Country:US
Practice Address - Phone:949-654-2727
Practice Address - Fax:949-654-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1212367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGNMW00160Medicaid