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General NPI Number Information
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NPI Number | 1689583635
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Entity Type | Individual
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Provider Name | EVERETT JACKSON AMBURN
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Gender | Male
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 5215 ASHE RD
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City | BAKERSFIELD
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State | CA
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Zip | 93313-2069
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Country | US
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Telephone | 661-872-3408
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Fax |
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Provider Business Mailing Address
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Address Line | 6721 ALDERBROOK LN
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City | BAKERSFIELD
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State | CA
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Zip | 93312-1896
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Country | US
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Telephone |
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Fax |
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 58365
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License Number State |
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