=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467454892
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN-BAPTIST N MUGEMA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2005
-----------------------------------------------------
Last Update Date | 07/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4580 CALIFORNIA AVE
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-327-4411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6515 PANAMA LN # 106-107
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-9726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-634-0955
-----------------------------------------------------
Fax | 661-634-9662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A75858
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------