Healthcare Provider Details

I. General information

NPI: 1346932894
Provider Name (Legal Business Name): PEBBLES LATRICE WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 N CHESTER AVE
BAKERSFIELD CA
93308-1770
US

IV. Provider business mailing address

2525 N CHESTER AVE
BAKERSFIELD CA
93308-1770
US

V. Phone/Fax

Practice location:
  • Phone: 661-686-1754
  • Fax:
Mailing address:
  • Phone: 661-868-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: