=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396559522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERN COUNTY HOSPITAL AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2025
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9300 STOCKDALE HWY STE 100
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-664-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 MOUNT VERNON AVE RM 1241
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93306-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-326-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF AMBULATORY OFFICER
-----------------------------------------------------
Name | RENEE VILLANUEVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-326-2682
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------