Basic Information
| Provider Information | |||||||||
| NPI: | 1467990598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAKERSFIELD SPECIALTY GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7253 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913074024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Practice Location | |||||||||
| Address1: | 3008 SILLECT AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933086340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | CARMONA | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8183487253 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.