Healthcare Provider Details

I. General information

NPI: 1598813115
Provider Name (Legal Business Name): SOUTHWEST PROFESSIONAL MEDICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 EMPIRE DR STE 100
BAKERSFIELD CA
93309-0400
US

IV. Provider business mailing address

4000 EMPIRE DR STE 100
BAKERSFIELD CA
93309-0400
US

V. Phone/Fax

Practice location:
  • Phone: 661-395-0155
  • Fax: 661-395-0102
Mailing address:
  • Phone: 661-395-0155
  • Fax: 661-395-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES L TAYLOR
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 661-395-0155