Healthcare Provider Details

I. General information

NPI: 1427551340
Provider Name (Legal Business Name): RIVERWALK MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 COMMERCE DRIVE
BAKERSFIELD CA
99309
US

IV. Provider business mailing address

1400 EASTON DR STE 143
BAKERSFIELD CA
93309-9404
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-4200
  • Fax:
Mailing address:
  • Phone: 661-324-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. VINOD KUMAR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 661-324-4100