Healthcare Provider Details

I. General information

NPI: 1245275668
Provider Name (Legal Business Name): S NICK HANSA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 TRUXTUN AVE
BAKERSFIELD CA
93309-0613
US

IV. Provider business mailing address

6401 TRUXTUN AVE
BAKERSFIELD CA
93309-0613
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-0739
  • Fax: 661-631-2210
Mailing address:
  • Phone: 661-327-0739
  • Fax: 661-631-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. S NICK HANSA
Title or Position: PRESIDENT
Credential: MD
Phone: 661-327-0739