Healthcare Provider Details

I. General information

NPI: 1972945111
Provider Name (Legal Business Name): KENDRA RHOADES COUCHOT PHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MOUNT VERNON AVE
BAKERSFIELD CA
93306-3302
US

IV. Provider business mailing address

1800 MOUNT VERNON AVE
BAKERSFIELD CA
93306-3302
US

V. Phone/Fax

Practice location:
  • Phone: 661-321-3000
  • Fax:
Mailing address:
  • Phone: 661-321-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0900X
TaxonomyMicrobiology Specialist/Technologist
License Number1656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: