Healthcare Provider Details

I. General information

NPI: 1649275264
Provider Name (Legal Business Name): ST. THERESE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W COLUMBUS ST
BAKERSFIELD CA
93301-1201
US

IV. Provider business mailing address

7702 MEANY AVE SUITE 105
BAKERSFIELD CA
93308-5199
US

V. Phone/Fax

Practice location:
  • Phone: 661-391-0305
  • Fax: 661-391-0313
Mailing address:
  • Phone: 661-391-0305
  • Fax: 661-391-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA42316
License Number StateCA

VIII. Authorized Official

Name: CINDY FERRIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-391-0305