Healthcare Provider Details

I. General information

NPI: 1437752656
Provider Name (Legal Business Name): SJV MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 TRUXTUN AVE
BAKERSFIELD CA
93309-0609
US

IV. Provider business mailing address

P.O. BOX 2426
BAKERSFIELD CA
93303-2426
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-3747
  • Fax: 661-616-3237
Mailing address:
  • Phone: 661-327-3747
  • Fax: 661-616-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NED DEVASIA
Title or Position: OWNER
Credential: MD
Phone: 661-327-3747