Provider Demographics
NPI:1457372534
Name:BAKERSFIELD CARDIOPULMONARY MED GRP
Entity Type:Organization
Organization Name:BAKERSFIELD CARDIOPULMONARY MED GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-323-5978
Mailing Address - Street 1:1524 27TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2055
Mailing Address - Country:US
Mailing Address - Phone:661-323-5976
Mailing Address - Fax:666-323-7748
Practice Address - Street 1:1524 27TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2055
Practice Address - Country:US
Practice Address - Phone:661-323-5976
Practice Address - Fax:666-323-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA237240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A237240Medicaid
CAZZZ82472ZMedicare PIN
CAA23653Medicare UPIN