Healthcare Provider Details

I. General information

NPI: 1164974739
Provider Name (Legal Business Name): KERN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 34TH ST SUITE 202
BAKERSFIELD CA
93301-2283
US

IV. Provider business mailing address

1700 MOUNT VERNON AVE ROOM 1241
BAKERSFIELD CA
93306-4018
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-326-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: RENEE VILLANUEVA
Title or Position: CHIEF AMBULATORY OFFICER
Credential:
Phone: 661-326-2682