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General NPI Number Information
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NPI Number | 1114094141
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Entity Type | Organization
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Legal Business Name | TRUXTUN PSYCHIATRIC MEDICAL GROUP
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 6001 TRUXTUN AVE SUITE #160
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City | BAKERSFIELD
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State | CA
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Zip | 93309-0679
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Country | US
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Telephone | 661-323-6410
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Fax | 661-323-7631
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Provider Business Mailing Address
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Address Line | 6001 TRUXTUN AVE SUITE #160
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City | BAKERSFIELD
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State | CA
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Zip | 93309-0679
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Country | US
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Telephone | 661-323-6410
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAKREPATNA A MANOHARA
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Credential | MD
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Telephone | 661-323-6410
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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 | A34791
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License Number State | CA
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