Basic Information
| Provider Information | |||||||||
| NPI: | 1326439977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC. | ||||||||
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| OtherOrganizationName: | SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - BAKERSFIELD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 VALLEY CHILDRENS PL | ||||||||
| Address2: | SC05 | ||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936368761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593535700 | ||||||||
| FaxNumber: | 5593535708 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 34TH ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618438980 | ||||||||
| FaxNumber: | 6618438981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2015 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | KAJI | ||||||||
| AuthorizedOfficialFirstName: | DEVONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5593535700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.