Healthcare Provider Details

I. General information

NPI: 1679775951
Provider Name (Legal Business Name): MARVIN J. DERRICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST STE A100
BAKERSFIELD CA
93301-2284
US

IV. Provider business mailing address

3838 SAN DIMAS ST STE A100
BAKERSFIELD CA
93301-2284
US

V. Phone/Fax

Practice location:
  • Phone: 661-377-8346
  • Fax: 661-327-0921
Mailing address:
  • Phone: 661-377-8346
  • Fax: 661-327-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARVIN J DERRICK
Title or Position: OWNER
Credential: M.D.
Phone: 661-377-8346