Healthcare Provider Details

I. General information

NPI: 1598044018
Provider Name (Legal Business Name): TRIBUNE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 19TH ST STE 400
BAKERSFIELD CA
93301-4440
US

IV. Provider business mailing address

1527 19TH ST STE 400
BAKERSFIELD CA
93301-4440
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-1213
  • Fax:
Mailing address:
  • Phone: 661-328-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number09713705
License Number StateCA

VIII. Authorized Official

Name: GREGG SWOBODA
Title or Position: OFFICER
Credential:
Phone: 661-371-8897