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General NPI Number Information
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NPI Number | 1104607308
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Entity Type | Individual
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Provider Name | COLE SCANLON
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Gender | Male
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1900 E BRUNDAGE LN STE 1
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City | BAKERSFIELD
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State | CA
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Zip | 93307-2732
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Country | US
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Telephone | 661-336-9967
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Fax |
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Provider Business Mailing Address
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Address Line | 8101 CAMINO MEDIA APT 157
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City | BAKERSFIELD
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State | CA
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Zip | 93311-2028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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