Healthcare Provider Details

I. General information

NPI: 1578604880
Provider Name (Legal Business Name): CALEB DAJAO QUEROL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 6TH ST
MADERA CA
93638-3631
US

IV. Provider business mailing address

4900 CALIFORNIA AVE STE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 661-459-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA97512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: