Provider Demographics
NPI:1427453737
Name:INJOYABLE BIRTH MIDWIFERY, PLLC
Entity type:Organization
Organization Name:INJOYABLE BIRTH MIDWIFERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:480-710-5665
Mailing Address - Street 1:1220 N SPENCER STE 200
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4300
Mailing Address - Country:US
Mailing Address - Phone:480-710-5665
Mailing Address - Fax:480-418-3366
Practice Address - Street 1:1220 N SPENCER STE 200
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4300
Practice Address - Country:US
Practice Address - Phone:480-710-5665
Practice Address - Fax:480-418-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM187176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLM187OtherAZ DEPARTMENT OF HEALTH SERVICES