Provider Demographics
NPI:1063713477
Name:SANTA LUCIA BIRTH CENTER, INC.
Entity type:Organization
Organization Name:SANTA LUCIA BIRTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LM
Authorized Official - Phone:805-548-0606
Mailing Address - Street 1:4251 S HIGUERA ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7700
Mailing Address - Country:US
Mailing Address - Phone:805-548-0606
Mailing Address - Fax:
Practice Address - Street 1:4251 S HIGUERA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7700
Practice Address - Country:US
Practice Address - Phone:805-548-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing