Healthcare Provider Details

I. General information

NPI: 1285819391
Provider Name (Legal Business Name): GOVINDAN BALASUBRAMANIAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 STOCKDALE HWY STE 200
BAKERSFIELD CA
93311-3611
US

IV. Provider business mailing address

PO BOX 2029
BAKERSFIELD CA
93303-2029
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-3700
  • Fax: 661-663-3737
Mailing address:
  • Phone: 661-335-7755
  • Fax: 661-335-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA39680
License Number StateCA

VIII. Authorized Official

Name: MRS. SANDY REED
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-335-7755