Healthcare Provider Details

I. General information

NPI: 1124161229
Provider Name (Legal Business Name): MICHAEL C TIVNON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD RIVER RD SUITE 150
BAKERSFIELD CA
93311-9503
US

IV. Provider business mailing address

300 OLD RIVER RD SUITE 150
BAKERSFIELD CA
93311-9503
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-7600
  • Fax: 661-663-7676
Mailing address:
  • Phone: 661-663-7600
  • Fax: 661-663-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA24851
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL C TIVNON
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 661-663-7600