Provider Demographics
NPI:1538104971
Name:BUMACOD, ESTRELITA B (RPT)
Entity Type:Individual
Prefix:
First Name:ESTRELITA
Middle Name:B
Last Name:BUMACOD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:ESTRELITA
Other - Middle Name:CORPUZ
Other - Last Name:BALITAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:2535 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3417
Mailing Address - Country:US
Mailing Address - Phone:661-308-8777
Mailing Address - Fax:661-374-4242
Practice Address - Street 1:2535 16TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3417
Practice Address - Country:US
Practice Address - Phone:661-308-8777
Practice Address - Fax:661-374-4242
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12164OtherLICENSE NO.