Provider Demographics
NPI:1689009888
Name:KINTU-SEBULIBA, OLIVE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:OLIVE
Middle Name:
Last Name:KINTU-SEBULIBA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 BATES DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3379
Mailing Address - Country:US
Mailing Address - Phone:714-986-9018
Mailing Address - Fax:
Practice Address - Street 1:947 SOUTH ANAHEIM BLVD
Practice Address - Street 2:# 240
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5584
Practice Address - Country:US
Practice Address - Phone:714-774-8870
Practice Address - Fax:714-635-5704
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1676176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife