Provider Demographics
NPI:1134574767
Name:BAKERSFIELD BIRTH CENTER
Entity type:Organization
Organization Name:BAKERSFIELD BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR, MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:O'CONNELL
Authorized Official - Last Name:BACKHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LM,CPM,IBCLC
Authorized Official - Phone:661-557-0639
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:661-821-0796
Practice Address - Street 1:6001 TRUXTUN AVE STE 360
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0679
Practice Address - Country:US
Practice Address - Phone:661-821-0659
Practice Address - Fax:661-821-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM185261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174645360OtherNPPES