Healthcare Provider Details

I. General information

NPI: 1083885263
Provider Name (Legal Business Name): CENTRAL NEPHROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 OFFICE PARK DR
BAKERSFIELD CA
93309-0612
US

IV. Provider business mailing address

5030 OFFICE PARK DR
BAKERSFIELD CA
93309-0612
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-4754
  • Fax: 661-323-0566
Mailing address:
  • Phone: 661-325-4754
  • Fax: 661-323-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. HAROLD J BAER
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 661-325-4754