Provider Demographics
NPI:1356581573
Name:BEACH SIDE BIRTH CENTER
Entity type:Organization
Organization Name:BEACH SIDE BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE AND BILLING MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-215-7575
Mailing Address - Street 1:23141 MOULTON PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1241
Mailing Address - Country:US
Mailing Address - Phone:949-215-7575
Mailing Address - Fax:949-215-5757
Practice Address - Street 1:23141 MOULTON PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1241
Practice Address - Country:US
Practice Address - Phone:949-215-7575
Practice Address - Fax:949-215-5757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACH CITIES MIDWIFERY & WOMEN'S HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-27
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001884261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR78924Medicare UPIN