Healthcare Provider Details

I. General information

NPI: 1942416169
Provider Name (Legal Business Name): WILLIAM F DINICOLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD RIVER RD STE 125
BAKERSFIELD CA
93311-9506
US

IV. Provider business mailing address

300 OLD RIVER RD STE 125
BAKERSFIELD CA
93311-9506
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-3122
  • Fax: 661-663-3133
Mailing address:
  • Phone: 661-663-3122
  • Fax: 661-663-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG17210
License Number StateCA

VIII. Authorized Official

Name: TERESA M WILLIAMS
Title or Position: CREDENTIALING
Credential:
Phone: 661-663-3122