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General NPI Number Information
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NPI Number | 1053593277
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Entity Type | Organization
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Legal Business Name | HECTOR DE JESUS M.D., INC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 2121 17TH ST STE A
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City | BAKERSFIELD
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State | CA
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Zip | 93301-3704
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Country | US
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Telephone | 661-323-3280
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Fax | 661-323-3388
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Provider Business Mailing Address
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Address Line | PO BOX 2647
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City | BAKERSFIELD
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State | CA
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Zip | 93303-2647
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Country | US
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Telephone | 661-323-3280
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Fax | 661-323-3388
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Authorized Official
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Title or Position | PRESIDENT
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Name | HECTOR M DE JESUS
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Credential | M. D.
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Telephone | 661-323-3280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OOA602230
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License Number State | CA
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