Healthcare Provider Details

I. General information

NPI: 1326964495
Provider Name (Legal Business Name): JASON GERONIMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14722 MERLOT CELLARS DR
BAKERSFIELD CA
93314-4747
US

IV. Provider business mailing address

14722 MERLOT CELLARS DR
BAKERSFIELD CA
93314-4747
US

V. Phone/Fax

Practice location:
  • Phone: 661-607-9160
  • Fax:
Mailing address:
  • Phone: 661-607-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number685001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: