Provider Demographics
NPI:1275186660
Name:NESHEIWAT, EDWARD JOB
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOB
Last Name:NESHEIWAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5215
Mailing Address - Country:US
Mailing Address - Phone:661-868-4544
Mailing Address - Fax:
Practice Address - Street 1:1415 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5215
Practice Address - Country:US
Practice Address - Phone:661-868-4544
Practice Address - Fax:661-868-4520
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator