Healthcare Provider Details

I. General information

NPI: 1548389992
Provider Name (Legal Business Name): MRS. AGNES HELENA ALEEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6113 TOBIAS WAY
BAKERSFIELD CA
93313-3470
US

IV. Provider business mailing address

2911 PARK MEADOWS DR APT. # 103
BAKERSFIELD CA
93308-5666
US

V. Phone/Fax

Practice location:
  • Phone: 661-835-7676
  • Fax: 661-835-7676
Mailing address:
  • Phone: 661-393-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: