Healthcare Provider Details

I. General information

NPI: 1750450698
Provider Name (Legal Business Name): CENTRAL NEPHROLOGY MEDICAL GRP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 OFFICE PARK DRIVE SUITE A
BAKERSFIELD CA
93309-0612
US

IV. Provider business mailing address

5030 OFFICE PARK DRIVE SUITE A
BAKERSFIELD CA
93309-0612
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-2847
  • Fax: 661-323-0566
Mailing address:
  • Phone: 661-323-2847
  • Fax: 661-323-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN BISOGNO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 661-323-2847