Healthcare Provider Details

I. General information

NPI: 1730357310
Provider Name (Legal Business Name): NNEKA D.I. ODELUGA CLS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 COMMERCE DR
BAKERSFIELD CA
93309-0631
US

IV. Provider business mailing address

PO BOX 1351
BAKERSFIELD CA
93302-1351
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-4100
  • Fax:
Mailing address:
  • Phone: 661-301-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: