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General NPI Number Information
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NPI Number | 1316664030
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Entity Type | Individual
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Provider Name | LONDON PHYLICIA RICHARD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 1018 21ST ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-4709
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Country | US
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Telephone | 661-861-9967
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 REESE AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93307-3857
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Country | US
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Telephone | 661-201-1570
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 711349
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License Number State | CA
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