Provider Demographics
NPI:1114052263
Name:AJOOTIAN, RICK M (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:M
Last Name:AJOOTIAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 NAIRN CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4267
Mailing Address - Country:US
Mailing Address - Phone:661-397-3515
Mailing Address - Fax:661-397-3515
Practice Address - Street 1:7909 NAIRN CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4267
Practice Address - Country:US
Practice Address - Phone:661-397-3515
Practice Address - Fax:661-397-3515
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ42105Medicare UPIN