Healthcare Provider Details

I. General information

NPI: 1639786122
Provider Name (Legal Business Name): MY VIRTUAL PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE FL 2
BAKERSFIELD CA
93309-7024
US

IV. Provider business mailing address

1 BERGEN ST APT 234
HARRISON NJ
07029-3198
US

V. Phone/Fax

Practice location:
  • Phone: 888-224-0804
  • Fax:
Mailing address:
  • Phone: 443-224-5142
  • Fax:

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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID LEIGHTON HOWARD
Title or Position: CEO
Credential: MD PHD
Phone: 888-224-0804