Basic Information
Provider Information
NPI: 1003007287
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GINN
FirstName: MICHAELA
MiddleName: ELIZABETH
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3400 DATA DR
Address2: QUALITY MANAGEMENT
City: RANCHO CORDOVA
State: CA
PostalCode: 956707956
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 9500 STOCKDALE HWY
Address2: STE 201
City: BAKERSFIELD
State: CA
PostalCode: 933113620
CountryCode: US
TelephoneNumber: 6613271431
FaxNumber: 6613213286
Other Information
ProviderEnumerationDate: 08/05/2007
LastUpdateDate: 01/06/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA111803CAY Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XN8098TXN Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
465153283401 MYUTMB 4651532834OTHER


Home