Healthcare Provider Details

I. General information

NPI: 1306351051
Provider Name (Legal Business Name): MIKE ARMENDARIZ I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 4TH ST
TAFT CA
93268-2433
US

IV. Provider business mailing address

29325 KIMBERLINA RD
WASCO CA
93280-7617
US

V. Phone/Fax

Practice location:
  • Phone: 661-765-7025
  • Fax:
Mailing address:
  • Phone: 661-758-4029
  • Fax: 661-758-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: