Healthcare Provider Details

I. General information

NPI: 1477933794
Provider Name (Legal Business Name): SAMANTHA CASSANDRA MADZIARSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 05/14/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BELLE TER
BAKERSFIELD CA
93307-3871
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8037
  • Fax: 661-868-8081
Mailing address:
  • Phone: 661-326-5411
  • Fax: 661-862-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA150322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: