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General NPI Number Information
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NPI Number | 1366992919
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Entity Type | Organization
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Legal Business Name | LAC MEDICAL, INC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 5300 LENNOX AVE STE 105
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City | BAKERSFIELD
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State | CA
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Zip | 93309-1662
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Country | US
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Telephone | 661-735-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 SILLECT AVE STE 201
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City | BAKERSFIELD
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State | CA
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Zip | 93308-6373
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Country | US
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Telephone | 661-327-2101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIPUL RAMAN DEV
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Credential | MD
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Telephone | 661-327-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G52726
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License Number State | CA
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