Healthcare Provider Details

I. General information

NPI: 1518259480
Provider Name (Legal Business Name): LINCY A MALIYEKKAL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD RIVER RD SUITE 155
BAKERSFIELD CA
93311-9504
US

IV. Provider business mailing address

500 OLD RIVER RD SUITE 155
BAKERSFIELD CA
93311-9504
US

V. Phone/Fax

Practice location:
  • Phone: 661-664-1230
  • Fax: 661-716-5484
Mailing address:
  • Phone: 661-664-1230
  • Fax: 661-663-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: