Provider Demographics
NPI:1124849591
Name:MOONRISE BIRTH COLLECTIVE
Entity type:Organization
Organization Name:MOONRISE BIRTH COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:407-312-2670
Mailing Address - Street 1:630 N DENNING DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3019
Mailing Address - Country:US
Mailing Address - Phone:407-312-2670
Mailing Address - Fax:689-227-7466
Practice Address - Street 1:630 N DENNING DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3019
Practice Address - Country:US
Practice Address - Phone:407-312-2670
Practice Address - Fax:689-227-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty