Provider Demographics
NPI:1619327137
Name:SAN DIEGO COUNTY MIDWIVES
Entity Type:Organization
Organization Name:SAN DIEGO COUNTY MIDWIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:619-957-0910
Mailing Address - Street 1:275 S WORTHINGTON ST SPC 120
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6344
Mailing Address - Country:US
Mailing Address - Phone:619-434-9011
Mailing Address - Fax:619-434-9199
Practice Address - Street 1:15644 POMERADO RD STE 302
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2455
Practice Address - Country:US
Practice Address - Phone:858-278-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM 162 & LM 297176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty