Healthcare Provider Details

I. General information

NPI: 1770575870
Provider Name (Legal Business Name): BRYAN HIEBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S MILL ST
TEHACHAPI CA
93561-2027
US

IV. Provider business mailing address

432 S MILL ST
TEHACHAPI CA
93561-2027
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-2273
  • Fax:
Mailing address:
  • Phone: 661-823-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA20588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: