Healthcare Provider Details

I. General information

NPI: 1205009461
Provider Name (Legal Business Name): G.B. HAERI M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 STOCKDALE HWY STE A
BAKERSFIELD CA
93309-2024
US

IV. Provider business mailing address

PO BOX 22
BAKERSFIELD CA
93302-0022
US

V. Phone/Fax

Practice location:
  • Phone: 661-834-4812
  • Fax: 661-335-7766
Mailing address:
  • Phone: 661-335-7755
  • Fax: 661-335-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA38702
License Number StateCA

VIII. Authorized Official

Name: DR. GHOL B HAERI-GHARAVI
Title or Position: OWNER/PRESIDENT/SOLE PROPRIETOR
Credential: M.D.
Phone: 661-335-7755