Basic Information
| Provider Information | |||||||||
| NPI: | 1700541877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KERN RIVER SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 GRAY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931011800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2901 SILLECT AVE STE 203 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933086373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053648450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2021 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | MOZINGO | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8055630363 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.