Healthcare Provider Details

I. General information

NPI: 1174392781
Provider Name (Legal Business Name): DESTINEE HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 21ST ST STE A
BAKERSFIELD CA
93301-4608
US

IV. Provider business mailing address

2342 PROFESSIONAL PKWY STE 300
SANTA MARIA CA
93455-6819
US

V. Phone/Fax

Practice location:
  • Phone: 805-979-9941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12690009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: