Healthcare Provider Details

I. General information

NPI: 1558144535
Provider Name (Legal Business Name): CENTRAL CARDIOLOGY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SILLECT AVE STE 100
BAKERSFIELD CA
93308-6372
US

IV. Provider business mailing address

5080 CALIFORNIA AVE STE 420
BAKERSFIELD CA
93309-1985
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-8384
  • Fax:
Mailing address:
  • Phone: 661-332-8812
  • Fax: 661-424-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARRIE A GARDNER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 661-371-2767