Provider Demographics
NPI:1215473095
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:DR
Authorized Official - First Name:IYABODE
Authorized Official - Middle Name:MUNIRAT
Authorized Official - Last Name:OGUNLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-488-7824
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:832-488-7824
Mailing Address - Fax:281-206-4487
Practice Address - Street 1:13523 HARGRAVE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3829
Practice Address - Country:US
Practice Address - Phone:832-488-7824
Practice Address - Fax:281-206-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing