Healthcare Provider Details

I. General information

NPI: 1154548212
Provider Name (Legal Business Name): PANAMA-BUENA VISTA UNION SD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 04/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 ASHE RD
BAKERSFIELD CA
93313-2029
US

IV. Provider business mailing address

4200 ASHE RD
BAKERSFIELD CA
93313-2029
US

V. Phone/Fax

Practice location:
  • Phone: 661-831-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. KATHERINE A GONZALEZ
Title or Position: ASSISTANT SUPERINTENDENT, BUSINESS
Credential:
Phone: 661-831-8331