Healthcare Provider Details

I. General information

NPI: 1346073376
Provider Name (Legal Business Name): JAQUELINE ZUNIGA MACIAS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 HIGHWAY 178
BAKERSFIELD CA
93306-9510
US

IV. Provider business mailing address

18200 HIGHWAY 178
BAKERSFIELD CA
93306-9510
US

V. Phone/Fax

Practice location:
  • Phone: 661-871-9697
  • Fax: 661-871-1270
Mailing address:
  • Phone: 661-871-9697
  • Fax: 661-871-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN736694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: