Healthcare Provider Details

I. General information

NPI: 1982026886
Provider Name (Legal Business Name): MANSUKH GHADIYA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MOUNT VERNON AVE SUITE 211-A
BAKERSFIELD CA
93306-3341
US

IV. Provider business mailing address

PO BOX 60770
BAKERSFIELD CA
93386-0770
US

V. Phone/Fax

Practice location:
  • Phone: 661-215-4948
  • Fax: 855-677-5701
Mailing address:
  • Phone: 661-215-4948
  • Fax: 855-677-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA71759
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANSUKH GHADIYA
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 661-215-4948