Healthcare Provider Details

I. General information

NPI: 1710406459
Provider Name (Legal Business Name): KERN ANESTHESIA ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21901 COTTONWOOD CT
TEHACHAPI CA
93561-7110
US

IV. Provider business mailing address

21901 COTTONWOOD CT
TEHACHAPI CA
93561-7110
US

V. Phone/Fax

Practice location:
  • Phone: 661-861-0011
  • Fax: 661-465-4150
Mailing address:
  • Phone: 661-861-0011
  • Fax: 661-465-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberNA4086
License Number StateCA

VIII. Authorized Official

Name: TERRI MATHEWS
Title or Position: BILLING
Credential:
Phone: 661-861-0011