Provider Demographics
NPI:1467454892
Name:MUGEMA, JOHN-BAPTIST N (MD)
Entity Type:Individual
Prefix:
First Name:JOHN-BAPTIST
Middle Name:N
Last Name:MUGEMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 PANAMA LN
Mailing Address - Street 2:# 106-107
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-9726
Mailing Address - Country:US
Mailing Address - Phone:661-634-0955
Mailing Address - Fax:661-634-9662
Practice Address - Street 1:4580 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1104
Practice Address - Country:US
Practice Address - Phone:661-327-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A758582OtherEMSG/SJCH MEDICARE PIN
CAH55463Medicare UPIN