Healthcare Provider Details

I. General information

NPI: 1124112248
Provider Name (Legal Business Name): SHALISE RANAE MUNOZ FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHALISE RANAE POLLOCK FNPC

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/19/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 4TH STREET
BAKERSFIELD CA
93304
US

IV. Provider business mailing address

1530 E 19TH ST
BAKERSFIELD CA
93305-5406
US

V. Phone/Fax

Practice location:
  • Phone: 661-631-3205
  • Fax: 661-328-0591
Mailing address:
  • Phone: 661-631-5895
  • Fax: 661-631-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number560836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: