Healthcare Provider Details

I. General information

NPI: 1477803609
Provider Name (Legal Business Name): RIVERWALK MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 COMMERCE DR STE E
BAKERSFIELD CA
93309-0631
US

IV. Provider business mailing address

1400 EASTON DR SUITE 143
BAKERSFIELD CA
93309-9412
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-4100
  • Fax:
Mailing address:
  • Phone: 661-328-6290
  • Fax: 661-631-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3498322
License Number StateCA

VIII. Authorized Official

Name: DR. VINOD KUMAR
Title or Position: OWNER/CEO
Credential: MD
Phone: 661-324-4100