Healthcare Provider Details

I. General information

NPI: 1750182309
Provider Name (Legal Business Name): AIMEE JISELLE BARAJAS BANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 21ST ST
BAKERSFIELD CA
93301-4709
US

IV. Provider business mailing address

1018 21ST ST
BAKERSFIELD CA
93301-4709
US

V. Phone/Fax

Practice location:
  • Phone: 661-861-9967
  • Fax:
Mailing address:
  • Phone: 661-861-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number745281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: