Organization
LAKE CITY BIRTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA FENNELL LM, CPM (OWNER)
(386) 288-0698
Entity
Organization
Contact information
Practice address
5113 256TH ST, O BRIEN, FL 32071-4435
(386) 299-0698
(800) 853-5087
Mailing address
5113 256TH ST, O BRIEN, FL 32071-4435
(386) 299-0698
(800) 853-5087
Taxonomy
Speciality
Code
Description
License number
State
261QB0400X
Birthing Clinic/Center
Primary
MW 294
FL
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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