Healthcare Provider Details

I. General information

NPI: 1467990598
Provider Name (Legal Business Name): BAKERSFIELD SPECIALTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 SILLECT AVE SUITE 100
BAKERSFIELD CA
93308-6340
US

IV. Provider business mailing address

7253 MEDICAL CENTER DR SUITE 500
WEST HILLS CA
91307-4024
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-7246
  • Fax: 818-348-7248
Mailing address:
  • Phone: 818-348-7246
  • Fax: 818-348-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER S CARMONA
Title or Position: COO
Credential:
Phone: 818-348-7253