Provider Demographics
NPI:1508314238
Name:MODESTO NATURAL BIRTH PLACE
Entity Type:Organization
Organization Name:MODESTO NATURAL BIRTH PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:209-482-8682
Mailing Address - Street 1:1608 SUNRISE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4678
Mailing Address - Country:US
Mailing Address - Phone:209-622-0226
Mailing Address - Fax:209-622-0220
Practice Address - Street 1:1608 SUNRISE AVE
Practice Address - Street 2:STE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4678
Practice Address - Country:US
Practice Address - Phone:209-622-0226
Practice Address - Fax:209-622-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing