=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689009888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVE KINTU-SEBULIBA CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2013
-----------------------------------------------------
Last Update Date | 09/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 947 SOUTH ANAHEIM BLVD # 240
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805-5584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-774-8870
-----------------------------------------------------
Fax | 714-635-5704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4502 BATES DR
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92886-3379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-986-9018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 1676
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------