Provider Demographics
NPI:1942416169
Name:WILLIAM F DINICOLA
Entity Type:Organization
Organization Name:WILLIAM F DINICOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-663-3122
Mailing Address - Street 1:300 OLD RIVER RD STE 125
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:661-663-3122
Mailing Address - Fax:661-663-3133
Practice Address - Street 1:300 OLD RIVER RD STE 125
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:661-663-3122
Practice Address - Fax:661-663-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40017Medicare UPIN