=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124161229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL C TIVNON MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 OLD RIVER RD SUITE 150
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-9503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-663-7600
-----------------------------------------------------
Fax | 661-663-7676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 OLD RIVER RD SUITE 150
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-9503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-663-7600
-----------------------------------------------------
Fax | 661-663-7676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | DR. MICHAEL C TIVNON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 661-663-7600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | A24851
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------