Healthcare Provider Details

I. General information

NPI: 1104759380
Provider Name (Legal Business Name): CHRIS H PERSEL CCM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 ASHE RD
BAKERSFIELD CA
93313-2069
US

IV. Provider business mailing address

5215 ASHE RD
BAKERSFIELD CA
93313-2069
US

V. Phone/Fax

Practice location:
  • Phone: 661-872-3408
  • Fax: 661-872-3408
Mailing address:
  • Phone: 661-872-3408
  • Fax: 661-872-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4243412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: