Healthcare Provider Details

I. General information

NPI: 1013136167
Provider Name (Legal Business Name): JUAN M PINON SUBSTANCE ABUSE COUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S UNION AVE
BAKERSFIELD CA
93307-3642
US

IV. Provider business mailing address

418 HAZEL ST
BAKERSFIELD CA
93307-2520
US

V. Phone/Fax

Practice location:
  • Phone: 661-321-0234
  • Fax: 661-321-9856
Mailing address:
  • Phone: 661-322-3821
  • Fax: 661-321-9856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP0412010953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: