Healthcare Provider Details

I. General information

NPI: 1336141787
Provider Name (Legal Business Name): ANDREW ZEPP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CALLOWAY DR BLDG 400
BAKERSFIELD CA
93312-2513
US

IV. Provider business mailing address

4580 CALIFORNIA AVE
BAKERSFIELD CA
93309-1104
US

V. Phone/Fax

Practice location:
  • Phone: 661-387-6000
  • Fax: 661-387-6893
Mailing address:
  • Phone: 661-327-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: