Healthcare Provider Details

I. General information

NPI: 1174802532
Provider Name (Legal Business Name): ENVISTA MEDICAL NECK AND BACK CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 COFFEE RD SUITE 3
BAKERSFIELD CA
93308-5049
US

IV. Provider business mailing address

3900 COFFEE RD STE 3
BAKERSFIELD CA
93308-5050
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-0700
  • Fax: 661-587-9131
Mailing address:
  • Phone: 661-587-0700
  • Fax: 661-587-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17041
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC22958
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC13886
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30202
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30545
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6314
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL ANDERS
Title or Position: CFO
Credential:
Phone: 661-587-0700