Healthcare Provider Details

I. General information

NPI: 1942719125
Provider Name (Legal Business Name): ARCHANA REDDY BONGURALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N CHESTER AVE
BAKERSFIELD CA
93308-4841
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 866-707-6664
  • Fax:
Mailing address:
  • Phone: 866-707-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA166699
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301112602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: