Healthcare Provider Details

I. General information

NPI: 1518593102
Provider Name (Legal Business Name): KRISTEN LAUREN MAGPURI MENDES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 10/24/2021
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SILLECT AVE STE 100
BAKERSFIELD CA
93308-6372
US

IV. Provider business mailing address

2901 SILLECT AVE STE 100
BAKERSFIELD CA
93308-6372
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-8384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: