Provider Demographics
NPI:1174645360
Name:BACKHAUS, JUSTINE OCONNELL (LM,CPM)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:OCONNELL
Last Name:BACKHAUS
Suffix:
Gender:F
Credentials:LM,CPM
Other - Prefix:MISS
Other - First Name:JUSTINE
Other - Middle Name:OCONNELL
Other - Last Name:OHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM,CPM
Mailing Address - Street 1:23801 COYOTE CT
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-9213
Mailing Address - Country:US
Mailing Address - Phone:661-821-0659
Mailing Address - Fax:661-821-0659
Practice Address - Street 1:23801 COYOTE CT
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-9213
Practice Address - Country:US
Practice Address - Phone:661-821-0659
Practice Address - Fax:661-821-0659
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM185176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife