Provider Demographics
NPI:1265853295
Name:PERSONALIZED FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:PERSONALIZED FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-201-5409
Mailing Address - Street 1:2308 HAGGIN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1563
Mailing Address - Country:US
Mailing Address - Phone:661-201-5409
Mailing Address - Fax:
Practice Address - Street 1:2308 HAGGIN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1563
Practice Address - Country:US
Practice Address - Phone:661-201-5409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5828261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care