Healthcare Provider Details

I. General information

NPI: 1386156164
Provider Name (Legal Business Name): BIG VALLEY MIDWIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 13TH ST STE 2
MODESTO CA
95354-2444
US

IV. Provider business mailing address

509 13TH ST STE 2
MODESTO CA
95354-2444
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-7981
  • Fax:
Mailing address:
  • Phone: 209-521-7981
  • Fax: 209-336-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: BROOKE N MYUNG
Title or Position: PARTNER
Credential: LM
Phone: 209-521-7981