Healthcare Provider Details

I. General information

NPI: 1568020709
Provider Name (Legal Business Name): BAKERSFIELD VASCULAR CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 Q ST STE 205
BAKERSFIELD CA
93301-1645
US

IV. Provider business mailing address

3550 Q ST STE 205
BAKERSFIELD CA
93301-1645
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-3712
  • Fax:
Mailing address:
  • Phone: 626-683-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEOPOLDO PUGA
Title or Position: OWNER
Credential: MD
Phone: 626-683-3712