Healthcare Provider Details

I. General information

NPI: 1760014658
Provider Name (Legal Business Name): BAKERSFIELD COMMONS SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 19TH ST
BAKERSFIELD CA
93301-3709
US

IV. Provider business mailing address

2120 19TH ST
BAKERSFIELD CA
93301-3709
US

V. Phone/Fax

Practice location:
  • Phone: 661-748-1905
  • Fax: 661-748-1935
Mailing address:
  • Phone: 661-748-1935
  • Fax: 661-478-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GANESH ACHARYA
Title or Position: OWNER
Credential:
Phone: 602-370-0721