Healthcare Provider Details

I. General information

NPI: 1790953719
Provider Name (Legal Business Name): PRIMECARE PHYSICIANS MEDICAL GRP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 STOCKDALE HWY STE 200
BAKERSFIELD CA
93311-3634
US

IV. Provider business mailing address

9900 STOCKDALE HWY STE 200
BAKERSFIELD CA
93311-3634
US

V. Phone/Fax

Practice location:
  • Phone: 661-599-1555
  • Fax: 661-000-0000
Mailing address:
  • Phone: 661-599-1555
  • Fax: 661-000-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMBIKA SOFTA
Title or Position: OWNER
Credential: MD
Phone: 661-599-1555