Healthcare Provider Details

I. General information

NPI: 1720600497
Provider Name (Legal Business Name): SUZZETH REID KINESIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST
BAKERSFIELD CA
93301-2284
US

IV. Provider business mailing address

7225 AKERS RD
BAKERSFIELD CA
93313-3971
US

V. Phone/Fax

Practice location:
  • Phone: 661-303-4455
  • Fax:
Mailing address:
  • Phone: 661-303-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: