Healthcare Provider Details

I. General information

NPI: 1275041212
Provider Name (Legal Business Name): GLORIA P PACLEB-CADIZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N CHESTER AVE
BAKERSFIELD CA
93308-4841
US

IV. Provider business mailing address

4900 CALIFORNIA AVE STE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 800-300-6664
  • Fax: 661-237-6650
Mailing address:
  • Phone: 800-300-6664
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number554470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: