Healthcare Provider Details

I. General information

NPI: 1215421102
Provider Name (Legal Business Name): GABRIEL GARCIA BARAJAS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 COLUMBUS ST
BAKERSFIELD CA
93305
US

IV. Provider business mailing address

1111 COLUMBUS ST STE 2000
BAKERSFIELD CA
93305-1938
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-326-5208
  • Fax: 661-326-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: