Healthcare Provider Details

I. General information

NPI: 1699777896
Provider Name (Legal Business Name): RUBEN PEDRO COMELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 EAST FRONT STRRET
BUTTONWILLOW CA
93206-0917
US

IV. Provider business mailing address

4900 CALIFORNIA AVE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1900
  • Fax: 661-459-1974
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG50201
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: