Healthcare Provider Details

I. General information

NPI: 1104339761
Provider Name (Legal Business Name): KERN COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 PANORAMA DR
BAKERSFIELD CA
93305-1219
US

IV. Provider business mailing address

1801 PANORAMA DRIVE STUDENT HEALTH AND WELLNESS CENTER
BAKERSFIELD CA
93305-1219
US

V. Phone/Fax

Practice location:
  • Phone: 661-395-4336
  • Fax:
Mailing address:
  • Phone: 661-395-4336
  • Fax: 661-395-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH A. MARTIN
Title or Position: INTERIM CHIEF FINANCIAL OFFICER
Credential:
Phone: 661-336-5124