Organization
ANDALUZ WATERBIRTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER GALLARDO CPM,LDM (DIRECTOR)
(503) 885-0228
Entity
Organization
Contact information
Practice address
19255 SW 65TH AVE STE 220, TUALATIN, OR 97062-9717
(503) 885-0228
Mailing address
PO BOX 657, NEWBERG, OR 97132-0657
(503) 885-0228
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
071523
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006509
—
OR
Enumeration date
06/09/2009
Last updated
06/09/2009
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