Healthcare Provider Details

I. General information

NPI: 1689228462
Provider Name (Legal Business Name): GAMEDAY SPORTS MEDICINE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 GILMORE AVE STE 100
BAKERSFIELD CA
93308-6342
US

IV. Provider business mailing address

2901 SILLECT AVE STE 201
BAKERSFIELD CA
93308-6373
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-2101
  • Fax: 661-327-2554
Mailing address:
  • Phone: 661-706-9444
  • Fax: 661-327-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIPUL RAMAN DEV
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 661-327-2101