Provider Demographics
NPI:1013699768
Name:BRIBIESCA, RAUL M
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:M
Last Name:BRIBIESCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 STOCKDALE HWY SUITE 150B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1770
Mailing Address - Country:US
Mailing Address - Phone:661-868-5010
Mailing Address - Fax:661-868-5066
Practice Address - Street 1:5121 STOCKDALE HWY STE 150B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2656
Practice Address - Country:US
Practice Address - Phone:661-868-5010
Practice Address - Fax:661-836-9665
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker