Healthcare Provider Details

I. General information

NPI: 1164230561
Provider Name (Legal Business Name): PRINCE EVEN ARDEN EUGENIO RN, CNOR, RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

9009 LILY CREST WAY
SHAFTER CA
93263-9459
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-584-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number95250672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: