Healthcare Provider Details

I. General information

NPI: 1417883240
Provider Name (Legal Business Name): DUSTIN MAX MCBRIDE CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 28TH ST
BAKERSFIELD CA
93301-1902
US

IV. Provider business mailing address

1711 28TH ST
BAKERSFIELD CA
93301-1902
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-5944
  • Fax:
Mailing address:
  • Phone: 661-323-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO05190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO05190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: