Healthcare Provider Details

I. General information

NPI: 1083877542
Provider Name (Legal Business Name): BAKERSFIELD OUTPATIENT SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 07/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHINA GRADE LOOP SUITE C
BAKERSFIELD CA
93308-1707
US

IV. Provider business mailing address

1404 FIELDSPRING DR
BAKERSFIELD CA
93311-3576
US

V. Phone/Fax

Practice location:
  • Phone: 661-340-9910
  • Fax:
Mailing address:
  • Phone: 661-858-0865
  • Fax: 661-858-0940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number38144
License Number StateCA

VIII. Authorized Official

Name: DR. SERGE V VERNE
Title or Position: ORAL & MAXILLOFACIAL SURGEON
Credential: D.D.S., M.D.
Phone: 661-865-4209