Healthcare Provider Details

I. General information

NPI: 1629541685
Provider Name (Legal Business Name): PINNACLE PRIMARY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 BRUNDAGE LN
BAKERSFIELD CA
93304-2949
US

IV. Provider business mailing address

1520 BRUNDAGE LN
BAKERSFIELD CA
93304-2949
US

V. Phone/Fax

Practice location:
  • Phone: 661-321-9138
  • Fax: 661-321-9186
Mailing address:
  • Phone: 661-321-9138
  • Fax: 661-321-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EURAL E. GORDON
Title or Position: OWNER
Credential: N.P. PAC
Phone: 661-321-9138