Healthcare Provider Details

I. General information

NPI: 1326439977
Provider Name (Legal Business Name): SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 34TH ST
BAKERSFIELD CA
93301-2107
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL SC05
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 661-843-8980
  • Fax: 661-843-8981
Mailing address:
  • Phone: 559-353-5700
  • Fax: 559-353-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DEVONNA KAJI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-353-5700