Healthcare Provider Details

I. General information

NPI: 1053713206
Provider Name (Legal Business Name): SALUD Y VIDA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 WHITE LN
BAKERSFIELD CA
93307-4677
US

IV. Provider business mailing address

1491 WHITE LN
BAKERSFIELD CA
93307-4677
US

V. Phone/Fax

Practice location:
  • Phone: 661-835-2600
  • Fax: 661-835-2603
Mailing address:
  • Phone: 661-835-2600
  • Fax: 661-835-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA20231
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA42316
License Number StateCA

VIII. Authorized Official

Name: DENISE PITTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-843-7841