Healthcare Provider Details

I. General information

NPI: 1043139397
Provider Name (Legal Business Name): XAVIER BACA ROBLEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E 11TH ST
HANFORD CA
93230-3966
US

IV. Provider business mailing address

230 E 11TH ST
HANFORD CA
93230-3966
US

V. Phone/Fax

Practice location:
  • Phone: 559-719-8571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86277238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: