Provider Demographics
NPI:1174968630
Name:NEWTON, LOGAN (CP, BOCO)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:NEWTON
Suffix:
Gender:M
Credentials:CP, BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 F ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1816
Mailing Address - Country:US
Mailing Address - Phone:661-323-5944
Mailing Address - Fax:661-323-2820
Practice Address - Street 1:2624 F ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1816
Practice Address - Country:US
Practice Address - Phone:661-323-5944
Practice Address - Fax:661-323-2820
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50285222Z00000X
DECP004038224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC50285OtherBOC
CP004038OtherABC