Provider Demographics
NPI:1215446497
Name:PRISTINE BIRTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:PRISTINE BIRTH & WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IYABODE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-206-4496
Mailing Address - Street 1:13523 HARGRAVE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3829
Mailing Address - Country:US
Mailing Address - Phone:281-206-4496
Mailing Address - Fax:
Practice Address - Street 1:6617 FM 2920 RD STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2636
Practice Address - Country:US
Practice Address - Phone:281-206-4496
Practice Address - Fax:281-206-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty