Provider Demographics
NPI:1255579710
Name:AQUANATAL BIRTH SPA, INC.
Entity type:Organization
Organization Name:AQUANATAL BIRTH SPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MOXLEY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPM/LICENSED MIDWIFE
Authorized Official - Phone:909-591-2924
Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:#209
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-591-2924
Mailing Address - Fax:909-297-3428
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:#209
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-591-2924
Practice Address - Fax:909-297-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing