Provider Demographics
NPI:1326439977
Name:SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC.
Entity Type:Organization
Organization Name:SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC.
Other - Org Name:SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - BAKERSFIELD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-353-5700
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL
Mailing Address - Street 2:SC05
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-5700
Mailing Address - Fax:559-353-5708
Practice Address - Street 1:1215 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2107
Practice Address - Country:US
Practice Address - Phone:661-843-8980
Practice Address - Fax:661-843-8981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-17
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty