Healthcare Provider Details

I. General information

NPI: 1124521018
Provider Name (Legal Business Name): VIPMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SILLECT AVE STE 201
BAKERSFIELD CA
93308-6373
US

IV. Provider business mailing address

2901 SILLECT AVE STE 201
BAKERSFIELD CA
93308-6373
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-2101
  • Fax: 661-327-2554
Mailing address:
  • Phone: 661-327-2101
  • Fax: 661-327-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA63639
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TY HECKMAN
Title or Position: MANAGER
Credential:
Phone: 661-327-2101