Provider Demographics
NPI:1851431811
Name:SAN DIEGO MIDWIFE INC.
Entity Type:Organization
Organization Name:SAN DIEGO MIDWIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDIWFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA SHEL
Authorized Official - Middle Name:NIKOLE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:760-213-7384
Mailing Address - Street 1:1141 BALOUR DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3913
Mailing Address - Country:US
Mailing Address - Phone:760-809-9396
Mailing Address - Fax:760-230-2986
Practice Address - Street 1:515 ENCINITAS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3737
Practice Address - Country:US
Practice Address - Phone:760-809-9396
Practice Address - Fax:760-230-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty