Provider Demographics
NPI:1033849344
Name:CHILD NEUROLOGY CENTER OF BAKERSFIELD
Entity Type:Organization
Organization Name:CHILD NEUROLOGY CENTER OF BAKERSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMUND
Authorized Official - Middle Name:ROQUE
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-718-6929
Mailing Address - Street 1:PO BOX 20787
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0787
Mailing Address - Country:US
Mailing Address - Phone:661-742-8436
Mailing Address - Fax:661-999-6655
Practice Address - Street 1:5701 YOUNG ST STE 203
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8897
Practice Address - Country:US
Practice Address - Phone:661-742-8436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsyGroup - Single Specialty