Basic Information
| Provider Information | |||||||||
| NPI: | 1063528495 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY ACTION PARTNERSHIP OF KERN FAMILY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 1ST STREET | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613365300 | ||||||||
| FaxNumber: | 6613365303 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 1ST STREET | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613365300 | ||||||||
| FaxNumber: | 6613365303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DREW | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6613365236 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207V00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208D00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | EAP11802F | 01 | CA | EAPC | OTHER | ZZT11802F | 01 | CA | MEDI-CAL | OTHER |