Provider Demographics
NPI:1922440775
Name:ANDALUZ BIRTH CENTER
Entity Type:Organization
Organization Name:ANDALUZ BIRTH CENTER
Other - Org Name:ANDALUZ WATERBIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:CPM LDM
Authorized Official - Phone:503-885-0228
Mailing Address - Street 1:3323 SW NAITO PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4672
Mailing Address - Country:US
Mailing Address - Phone:503-885-0228
Mailing Address - Fax:
Practice Address - Street 1:3323 SW NAITO PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4672
Practice Address - Country:US
Practice Address - Phone:503-885-0228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-1000044176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty