Healthcare Provider Details

I. General information

NPI: 1003920935
Provider Name (Legal Business Name): SOUTH WEST PEDIATRICS A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 BLDG. A TRUXTUN AVENUE STE. 180
BAKERSFIELD CA
93309-0679
US

IV. Provider business mailing address

6001 BLDG. A TRUXTUN AVENUE STE. 180
BAKERSFIELD CA
93309-0679
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-8687
  • Fax: 661-325-4505
Mailing address:
  • Phone: 661-322-8687
  • Fax: 661-325-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA043422
License Number StateCA

VIII. Authorized Official

Name: MISS KRISTINA ANN WHITMORE
Title or Position: INSURANCE BILLER
Credential:
Phone: 661-322-8687