Healthcare Provider Details

I. General information

NPI: 1720427107
Provider Name (Legal Business Name): CALIFORNIA ENT FACIAL PLASTICS INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 TRUXTUN AVE
BAKERSFIELD CA
93309-0633
US

IV. Provider business mailing address

6501 TRUXTUN AVE
BAKERSFIELD CA
93309-0633
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-2206
  • Fax: 661-327-7027
Mailing address:
  • Phone: 661-322-2206
  • Fax: 661-327-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberC52571
License Number StateCA

VIII. Authorized Official

Name: SHERIF M AMMAR
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 661-322-2206