Basic Information
Provider Information
NPI: 1245543065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHIQUILLO SOSA
FirstName: RAFAEL
MiddleName: A
NamePrefix: MR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1559
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933021559
CountryCode: US
TelephoneNumber: 6616353050
FaxNumber: 6618691503
Practice Location
Address1: 7800 NILES ST
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933064922
CountryCode: US
TelephoneNumber: 6613284284
FaxNumber: 6616169980
Other Information
ProviderEnumerationDate: 07/21/2010
LastUpdateDate: 12/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000XA144954CAY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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