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General NPI Number Information
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NPI Number | 1760680482
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Entity Type | Organization
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Legal Business Name | ANCIENT PATHS MIDWIFERY
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 5849 SCHAEFER AVE
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City | CHINO
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State | CA
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Zip | 91710-7004
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Country | US
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Telephone | 909-464-0974
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Fax | 888-224-8755
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Provider Business Mailing Address
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Address Line | 5849 SCHAEFER AVE
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City | CHINO
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State | CA
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Zip | 91710-7004
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Country | US
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Telephone | 909-464-0974
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Fax | 888-224-8755
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LORI JEAN LUYTEN
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Credential | LM, CPM
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Telephone | 909-464-0974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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