Healthcare Provider Details

I. General information

NPI: 1932606167
Provider Name (Legal Business Name): RAMON MANSILUNGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 ALDRIN CT
BAKERSFIELD CA
93313-2103
US

IV. Provider business mailing address

5400 ALDRIN CT
BAKERSFIELD CA
93313-2103
US

V. Phone/Fax

Practice location:
  • Phone: 661-978-8007
  • Fax:
Mailing address:
  • Phone: 661-978-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: