Healthcare Provider Details

I. General information

NPI: 1891086971
Provider Name (Legal Business Name): MEDICAL NETWORK MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 F ST
BAKERSFIELD CA
93301-1815
US

IV. Provider business mailing address

2619 F ST
BAKERSFIELD CA
93301-1815
US

V. Phone/Fax

Practice location:
  • Phone: 661-861-0011
  • Fax:
Mailing address:
  • Phone: 661-861-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name: DR. MARSHALL SAUL LEWIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-861-0011