Healthcare Provider Details

I. General information

NPI: 1851311492
Provider Name (Legal Business Name): JOHN DEROUEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SAN DIMAS ST
BAKERSFIELD CA
93301-1456
US

IV. Provider business mailing address

PO BOX 2029
BAKERSFIELD CA
93303-2029
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-3700
  • Fax:
Mailing address:
  • Phone: 661-843-7616
  • Fax: 661-760-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG76575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: