Healthcare Provider Details

I. General information

NPI: 1316177827
Provider Name (Legal Business Name): COMPREHENSIVE PEDIATRICS AND FAMILY PRACTICE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 COLUMBUS ST STE. 1100
BAKERSFIELD CA
93305-1936
US

IV. Provider business mailing address

PO BOX 6578
BAKERSFIELD CA
93386-6578
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-6546
  • Fax: 661-862-7635
Mailing address:
  • Phone: 661-872-3311
  • Fax: 661-872-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberA106174
License Number StateCA

VIII. Authorized Official

Name: ABU TAHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-326-6546