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General NPI Number Information
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NPI Number | 1033849344
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Entity Type | Organization
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Legal Business Name | CHILD NEUROLOGY CENTER OF BAKERSFIELD
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 5701 YOUNG ST STE 203
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City | BAKERSFIELD
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State | CA
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Zip | 93311-8897
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Country | US
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Telephone | 661-742-8436
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20787
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City | BAKERSFIELD
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State | CA
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Zip | 93390-0787
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Country | US
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Telephone | 661-742-8436
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Fax | 661-999-6655
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Authorized Official
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Title or Position | CEO
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Name | DR. RAYMUND ROQUE DAVID
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Credential | MD
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Telephone | 559-718-6929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number |
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License Number State |
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