Healthcare Provider Details

I. General information

NPI: 1598906521
Provider Name (Legal Business Name): PEDIATRIC HEART CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD RIVER RD SUITE 105
BAKERSFIELD CA
93311-9504
US

IV. Provider business mailing address

PO BOX 6489
TORRANCE CA
90504-0489
US

V. Phone/Fax

Practice location:
  • Phone: 877-664-0808
  • Fax: 800-691-2492
Mailing address:
  • Phone: 877-664-0808
  • Fax: 800-691-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA83169
License Number StateCA

VIII. Authorized Official

Name: DR. AARON ELIJAH BANKS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 877-664-0808