Healthcare Provider Details

I. General information

NPI: 1295796100
Provider Name (Legal Business Name): JANICE K POLLETTA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE P KORDES NP

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105W E ST
TEHACHAPI CA
93561-1607
US

IV. Provider business mailing address

105W E ST
TEHACHAPI CA
93561-1607
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-7070
  • Fax: 661-823-0235
Mailing address:
  • Phone: 661-823-7070
  • Fax: 661-823-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number158982
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP5001044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: