Healthcare Provider Details

I. General information

NPI: 1346009065
Provider Name (Legal Business Name): JACLYNNICOLE C PADRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN PADRON

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MAST AVE
MC FARLAND CA
93250-1600
US

IV. Provider business mailing address

1300 17TH ST
BAKERSFIELD CA
93301-4504
US

V. Phone/Fax

Practice location:
  • Phone: 661-792-3340
  • Fax:
Mailing address:
  • Phone: 661-636-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: