Healthcare Provider Details

I. General information

NPI: 1508314238
Provider Name (Legal Business Name): MODESTO NATURAL BIRTH PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2016
Last Update Date: 09/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 SUNRISE AVE STE A
MODESTO CA
95350-4678
US

IV. Provider business mailing address

1608 SUNRISE AVE STE A
MODESTO CA
95350-4678
US

V. Phone/Fax

Practice location:
  • Phone: 209-622-0226
  • Fax: 209-622-0220
Mailing address:
  • Phone: 209-622-0226
  • Fax: 209-622-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ALLISON JOHNSON
Title or Position: OWNER, LICENSED MIDWIFE
Credential: LM
Phone: 209-482-8682