Healthcare Provider Details

I. General information

NPI: 1538104971
Provider Name (Legal Business Name): ESTRELITA B BUMACOD R.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ESTRELITA CORPUZ BALITAO R.P.T.

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 16TH ST
BAKERSFIELD CA
93301-3417
US

IV. Provider business mailing address

2535 16TH ST
BAKERSFIELD CA
93301-3417
US

V. Phone/Fax

Practice location:
  • Phone: 661-308-8777
  • Fax: 661-374-4242
Mailing address:
  • Phone: 661-308-8777
  • Fax: 661-374-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT12164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: