Basic Information
| Provider Information | |||||||||
| NPI: | 1467689430 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR WOMEN'S HEALTH AND FAMILY BIRTH | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 210 S PALISADE DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059220481 | ||||||||
| FaxNumber: | 8059255261 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 S PALISADE DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059220481 | ||||||||
| FaxNumber: | 8059255261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | CALLAHAN | ||||||||
| AuthorizedOfficialFirstName: | TAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8059220481 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | A24996 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | 261Q00000X | A29996 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 00A249960 | 05 | CA | MEDICAID |