Healthcare Provider Details

I. General information

NPI: 1053866244
Provider Name (Legal Business Name): DOMINADOR CABILDO IGNACIO III NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE SUITE 400B
BAKERSFIELD CA
93309-7024
US

IV. Provider business mailing address

4900 CALIFORNIA AVENUE, SUITE 400-B
BAKERSFIELD CA
93309
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1900
  • Fax:
Mailing address:
  • Phone: 925-421-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95023906
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: