Healthcare Provider Details

I. General information

NPI: 1609144039
Provider Name (Legal Business Name): MOHAWK MEDICAL & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 BRIMHALL RD
BAKERSFIELD CA
93312-2801
US

IV. Provider business mailing address

PO BOX 9879
BAKERSFIELD CA
93389-1879
US

V. Phone/Fax

Practice location:
  • Phone: 661-321-3288
  • Fax: 661-847-3267
Mailing address:
  • Phone: 661-321-3288
  • Fax: 661-847-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG39608
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG39608
License Number StateCA

VIII. Authorized Official

Name: JORGE E. DEL TORO
Title or Position: OWNER
Credential: M.D.
Phone: 661-847-3231