Healthcare Provider Details

I. General information

NPI: 1316392756
Provider Name (Legal Business Name): ADDIAS MERVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 34TH ST STE 100&200
BAKERSFIELD CA
93301-2305
US

IV. Provider business mailing address

625 34TH ST STE 100&200
BAKERSFIELD CA
93301-2305
US

V. Phone/Fax

Practice location:
  • Phone: 833-678-2781
  • Fax:
Mailing address:
  • Phone: 833-678-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number67250
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA183295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: