Healthcare Provider Details

I. General information

NPI: 1235624255
Provider Name (Legal Business Name): DATA OSAWUONAME DON-PEDRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 09/09/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE SUITE 400B
BAKERSFIELD CA
93309
US

IV. Provider business mailing address

4900 CALIFORNIA AVE STE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1900
  • Fax: 661-459-1974
Mailing address:
  • Phone: 661-630-7047
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number174423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: