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General NPI Number Information
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NPI Number | 1700017142
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Entity Type | Organization
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Legal Business Name | TRIBUNE MEDICAL GROUP
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1818 NILES ST
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City | BAKERSFIELD
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State | CA
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Zip | 93305-4910
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Country | US
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Telephone | 661-865-8893
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22096
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City | BAKERSFIELD
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State | CA
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Zip | 93390-2096
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Country | US
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Telephone | 661-865-8893
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. IAIN GALLEGO
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Credential | FNP-C; PA-C
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Telephone | 661-865-8893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C3604747
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License Number State | CA
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