Healthcare Provider Details

I. General information

NPI: 1477721769
Provider Name (Legal Business Name): MR. MARK ALAN KIRKLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 W. CECIL AVE.
DELANO CA
93215
US

IV. Provider business mailing address

2737 W. CECIL AVE.
DELANO CA
93215
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-2345
  • Fax: 661-721-6262
Mailing address:
  • Phone: 661-721-2345
  • Fax: 661-721-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: