| Organization Name: | BLOOM WATERBIRTH AND WELLNESS CENTER |
| NPI Number: | 1053783332 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HEIDI CHRISTINE MARSHALL (CO-OWNER AND LICENSED MIDWIFE) |
| Mailing Address: | 530 S Main St Ukiah |
| State: | CA US |
| Postal Code: | 954824926 |
| Phone Number: | 7076717476 |
| Fax Number: | 7076717478 |
| NPI Enumeration Date: | 10/26/2015 |
| NPI Last Update Date: | 10/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QB0400X |
| License Number: | 263 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Birthing |
| Taxonomy Definition: | |