Healthcare Provider Details

I. General information

NPI: 1427146208
Provider Name (Legal Business Name): WILLIAM F DINICOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD RIVER RD 125
BAKERSFIELD CA
93311-9503
US

IV. Provider business mailing address

300 OLD RIVER RD 125
BAKERSFIELD CA
93311-9503
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG17210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: