Healthcare Provider Details

I. General information

NPI: 1528112711
Provider Name (Legal Business Name): BAKERSFIELD SURGERY INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610 STOCKDALE HIGHWAY UNIT A
BAKESRSFIELD CA
93311-3626
US

IV. Provider business mailing address

9001 WILSHIRE BLVD SUITE 106
BEVERLY HILLS CA
90211-1838
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-8885
  • Fax:
Mailing address:
  • Phone: 310-273-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA84519
License Number StateCA

VIII. Authorized Official

Name: MR. THOMAS CLOUD
Title or Position: DIRECTOR
Credential: MPH
Phone: 310-273-8885