Healthcare Provider Details

I. General information

NPI: 1730483793
Provider Name (Legal Business Name): OSCAR CISNEROS-ROCHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S UNION AVE SUITE 100
BAKERSFIELD CA
93307-4179
US

IV. Provider business mailing address

PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 661-397-8775
  • Fax: 661-397-8286
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-869-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: