Provider Demographics
NPI:1053017046
Name:SOUTH BAY BIRTH
Entity type:Organization
Organization Name:SOUTH BAY BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LM CPM
Authorized Official - Phone:310-663-8175
Mailing Address - Street 1:700 N PACIFIC COAST HWY STE 202B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2147
Mailing Address - Country:US
Mailing Address - Phone:310-663-8175
Mailing Address - Fax:310-773-9031
Practice Address - Street 1:700 N PACIFIC COAST HWY STE 202B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2147
Practice Address - Country:US
Practice Address - Phone:310-663-8175
Practice Address - Fax:310-773-9031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BAY BIRTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing