=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366706764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAKERSFIELD DERMATOLOGY AND SKIN CANCER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2012
-----------------------------------------------------
Last Update Date | 06/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 CALIFORNIA AVE
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-322-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 496084
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96049-6084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-322-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DANIEL TAHERI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 661-322-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------