Provider Demographics
NPI:1760680482
Name:ANCIENT PATHS MIDWIFERY
Entity Type:Organization
Organization Name:ANCIENT PATHS MIDWIFERY
Other - Org Name:ANCIENT PATHS MIDWIFERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LUYTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:909-464-0974
Mailing Address - Street 1:5849 SCHAEFER AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7004
Mailing Address - Country:US
Mailing Address - Phone:909-464-0974
Mailing Address - Fax:888-224-8755
Practice Address - Street 1:5849 SCHAEFER AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7004
Practice Address - Country:US
Practice Address - Phone:909-464-0974
Practice Address - Fax:888-224-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing