Healthcare Provider Details

I. General information

NPI: 1720706955
Provider Name (Legal Business Name): MARIO ANDRES INIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 17TH ST
BAKERSFIELD CA
93301-4504
US

IV. Provider business mailing address

1300 17TH ST
BAKERSFIELD CA
93301-4504
US

V. Phone/Fax

Practice location:
  • Phone: 661-852-5660
  • Fax:
Mailing address:
  • Phone: 661-852-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: