Healthcare Provider Details

I. General information

NPI: 1760727366
Provider Name (Legal Business Name): JUSTIN S. TOBIAS M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BAHAMAS DR STE 100
BAKERSFIELD CA
93309-0746
US

IV. Provider business mailing address

1709 20TH ST
BAKERSFIELD CA
93301-3903
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-2333
  • Fax:
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 NumberA82042
License Number StateCA

VIII. Authorized Official

Name: JUSTIN TOBIAS
Title or Position: PRESIDENT
Credential: MD
Phone: 661-703-8016