Healthcare Provider Details

I. General information

NPI: 1316371370
Provider Name (Legal Business Name): ETHEL BIBAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

2201 MOUNT VERNON AVE SUITE 113
BAKERSFIELD CA
93306-3341
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-868-8269
  • Fax: 661-872-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number22893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: