Provider Demographics
NPI:1508407537
Name:RUFUS, POONAM
Entity Type:Individual
Prefix:
First Name:POONAM
Middle Name:
Last Name:RUFUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 EAGLE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9018
Mailing Address - Country:US
Mailing Address - Phone:661-378-8603
Mailing Address - Fax:
Practice Address - Street 1:10702 EAGLE VISTA DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9018
Practice Address - Country:US
Practice Address - Phone:661-378-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1111111171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator