Healthcare Provider Details

I. General information

NPI: 1962653097
Provider Name (Legal Business Name): ST THERESE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 CHINA GRADE LOOP
BAKERSFIELD CA
93308-1707
US

IV. Provider business mailing address

223 CHINA GRADE LOOP
BAKERSFIELD CA
93308-1707
US

V. Phone/Fax

Practice location:
  • Phone: 661-391-0316
  • Fax: 661-391-0313
Mailing address:
  • Phone: 661-391-0316
  • Fax: 661-391-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA34791
License Number StateCA

VIII. Authorized Official

Name: MRS. CINDY FERRIS
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 661-215-7659