Provider Demographics
NPI:1619386042
Name:BAKERSFIELD PEDIATRICS, A MEDICAL GROUP
Entity Type:Organization
Organization Name:BAKERSFIELD PEDIATRICS, A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-663-4720
Mailing Address - Street 1:300 OLD RIVER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9506
Mailing Address - Country:US
Mailing Address - Phone:661-663-4720
Mailing Address - Fax:661-663-4740
Practice Address - Street 1:300 OLD RIVER RD STE 105
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9506
Practice Address - Country:US
Practice Address - Phone:661-663-4720
Practice Address - Fax:661-663-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty