Healthcare Provider Details

I. General information

NPI: 1992585608
Provider Name (Legal Business Name): JEREMY EMANUEL SHUMAKER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 COLLEGE AVE
BAKERSFIELD CA
93305-4113
US

IV. Provider business mailing address

12517 WOODSON BRIDGE DR
BAKERSFIELD CA
93311-5105
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8080
  • Fax:
Mailing address:
  • Phone: 661-431-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: