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General NPI Number Information
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NPI Number | 1487973319
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Entity Type | Individual
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Provider Name | ANDREW BALDOMERO GONZALEZ OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 1603 CALIFORNIA AVE SUITE 103
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City | BAKERSFIELD
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State | CA
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Zip | 93304-1383
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Country | US
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Telephone | 661-204-1985
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Fax | 661-670-5277
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Provider Business Mailing Address
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Address Line | 1603 CALIFORNIA AVE SUITE 103
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City | BAKERSFIELD
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State | CA
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Zip | 93304-1383
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Country | US
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Telephone | 661-204-1985
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Fax | 661-670-5277
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | SL 6043
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License Number State | CA
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