Healthcare Provider Details

I. General information

NPI: 1932749108
Provider Name (Legal Business Name): VANGUARD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 HAGEMAN RD
BAKERSFIELD CA
93312-1959
US

IV. Provider business mailing address

565 KERN ST
SHAFTER CA
93263-2133
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1010
  • Fax: 855-200-2829
Mailing address:
  • Phone: 661-459-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NOVIRA SUNNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-599-5310