Healthcare Provider Details

I. General information

NPI: 1114435047
Provider Name (Legal Business Name): URIEL PAYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 27TH ST
BAKERSFIELD CA
93301-2807
US

IV. Provider business mailing address

6403 TRINIDAD AVE
BAKERSFIELD CA
93313-6001
US

V. Phone/Fax

Practice location:
  • Phone: 661-699-0366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: