Healthcare Provider Details

I. General information

NPI: 1811362908
Provider Name (Legal Business Name): SHAFTER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MUNZER ST SUITE C
SHAFTER CA
93263
US

IV. Provider business mailing address

PO BOX 22694
BAKERSFIELD CA
93390-2694
US

V. Phone/Fax

Practice location:
  • Phone: 661-364-5244
  • Fax:
Mailing address:
  • Phone: 661-364-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. AYODEJI ADETAYO AYENI
Title or Position: OWNER
Credential: MD
Phone: 661-364-5244