Healthcare Provider Details

I. General information

NPI: 1851612246
Provider Name (Legal Business Name): RENE MARCIAL VENEGAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2168
  • Fax: 661-326-2167
Mailing address:
  • Phone: 661-326-2168
  • Fax: 661-326-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA120024
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMDR-5916
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: