Provider Demographics
NPI:1487064325
Name:FAMILY CENTERED BIRTH
Entity type:Organization
Organization Name:FAMILY CENTERED BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTHAST
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:714-812-5275
Mailing Address - Street 1:1820 FULLERTON AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7001
Mailing Address - Country:US
Mailing Address - Phone:714-812-5275
Mailing Address - Fax:208-979-5283
Practice Address - Street 1:17399 HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-7092
Practice Address - Country:US
Practice Address - Phone:714-812-5275
Practice Address - Fax:208-979-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM347261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing