=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265660948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PADMALATHA KOMMINENI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2009
-----------------------------------------------------
Last Update Date | 07/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1491 WHITE LN
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93307-4677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-827-9183
-----------------------------------------------------
Fax | 661-827-9185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 SCENIC RIVER LN APT 3D
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93308-7504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-679-4259
-----------------------------------------------------
Fax | 661-679-4259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 57869
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------