Healthcare Provider Details

I. General information

NPI: 1891032512
Provider Name (Legal Business Name): BEHROOZ BANIHASHEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 CALIFORNIA AVE 500
BAKERSFIELD CA
93309-7020
US

IV. Provider business mailing address

4550 CALIFORNIA AVE 500
BAKERSFIELD CA
93309-7020
US

V. Phone/Fax

Practice location:
  • Phone: 661-716-7100
  • Fax: 661-716-5484
Mailing address:
  • Phone: 661-716-3484
  • Fax: 661-716-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA134421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: