SAN JOAQUIN WELLNESS & MEDICAL GROUP, INC (NPI# 1679673719) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679673719 |
| Entity Type | Organization |
| Organization Name | SAN JOAQUIN WELLNESS & MEDICAL GROUP, INC |
| Practice Address |
1201 24th St B-200 Bakersfield CA 93301-2310 |
| Practice Telephone | 6613244431 |
| Practice Fax Number | 6613245616 |
| Mailing Telephone | 6613244431 |
| Mailing Fax Number | 6613245616 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2008-04-30 |
| Authorized Official Name | DR. VINCENT STEVEN BOOTH (CLINIC DIRECTOR) |
| Authorized Official Telephone | 6613244431 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | DC0143200 | CA | Chiropractic Providers |
| Y | 208D00000X | General Practice | A89666 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
1201 24TH ST B-200 |
| City | BAKERSFIELD |
| State | CA |
| Zip Code | 93301-2310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497396030 | Ravleen Kaur | Dentist | 1201 24th St, Bakersfield, CA 93301-2300 | 2019-10-04 |
| 1497231385 | Yoojin Lee | Dentist | 1201 24th St, Bakersfield, CA 93301-2300 | 2018-07-14 |
| 1093238610 | Euijoon Park | Dentist | 1201 24th St, Bakersfield, CA 93301-2300 | 2017-07-25 |
| 1043624059 | Diana Lee | Pharmacist | 1201 24th St, Suite B-120, Bakersfield, CA 93301-2300 | 2014-06-17 |
| 1104152719 | Madhuri Kothapalli | Dentist | 1201 24th St, Suite A, Bakersfield, CA 93301-2300 | 2009-11-02 |
| 1104909357 | Chan Woo Lee | General Practice | 1201 24th St, B-200, Bakersfield, CA 93301-2310 | 2006-10-23 |
| 1699867317 | L & L Pharmacy Inc | Pharmacy | 1201 24th St, Suite B120, Bakersfield, CA 93301-2300 | 2006-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699389528 | Tsoguik Broutian | Case Manager/Care Coordinator | Kern County Superintendent of Schools, 1300 17th St., Bakersfield, CA 93301 | 2020-09-08 |
| 1124665559 | Flourish Family Wellness Psychological Services, Inc. | Marriage & Family Therapist | 1909 16th Street, Suite 7, Bakersfield, CA 93301 | 2019-12-04 |
| 1063066231 | Alexandra Moo | Case Manager/Care Coordinator | 1415 Trutun Ave, Bakersfield, CA 93301 | 2019-07-26 |
| 1245898659 | Michael Dean Sampley | Marriage & Family Therapist | 2025 Westwind Dr. Ste. A, Bakersfield, CA 93301 | 2019-05-31 |
| 1740751619 | Jimmy Garcia | Counselor | Aegis Treatment Center, 1018 21st St, Bakersfield, CA 93301 | 2018-12-17 |
| 1689140741 | Prism Pain and Spine, Inc | Physical Medicine & Rehabilitation | 3838 San Dimas, Ste., 3838 San Dimas,ste. B-231, Bakersfield, CA 93301 | 2018-10-16 |
| 1215437678 | Andria Sousa | Behavior Technician | 2535 16th St Ste 215&210, Bakersfield, CA 93301 | 2018-02-12 |
| 1003329889 | County of Kern | Clinic/Center | 820 34th Street, Suite 100,201,202, 203, Bakersfield, CA 93301 | 2017-11-15 |
| 1306358577 | Ashley Marie Pereida | Case Manager/Care Coordinator | 3300 Truxtun Ave. Suite 200, Bakersfield, CA 93301 | 2017-10-28 |
| 1982123113 | Amber Freer Hayes | Licensed Vocational Nurse | 2001, 28th Street, Bakersfield, CA 93301 | 2017-09-19 |
| Find all providers in zip 93301 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285046136 | Hamlet Garcia-pena | General Practice | 7800 Niles Street, Bakersfield, CA 93306-4937 | 2014-05-27 |
| 1619252525 | Christopher Reade Parks | General Practice | 9450 Ming Ave., Bakersfield, CA 93311 | 2011-10-12 |
| 1942519558 | Covenant Community Medical Group, Inc. | General Practice | 3803 Union Ave, Bakersfield, CA 93305-2400 | 2010-09-29 |
| 1417165606 | Pacific Medical Group | General Practice | 3201 F St Ste 250, Bakersfield, CA 93301-1846 | 2007-05-19 |
| 1073605150 | Thomas Robert Phelps | General Practice | 2001 Old Farm Rd, Bakersfield, CA 93312-3521 | 2006-09-28 |
| 1649284670 | George Ibrahim Girgis | General Practice | 14004 Fremantle Ct, Bakersfield, CA 93314-9298 | 2006-07-27 |
| 1477598910 | Hanhey Moon | General Practice | 1491 White Lane, Bakersfield, CA 93307 | 2006-06-18 |
| 1578503256 | Ronnie Claiborne | General Practice | 1925 17th Street, Bakersfield, CA 93301-5012 | 2006-06-08 |
| 1912991233 | Jerry Lynn Seydel | General Practice | 2801 Spruce St, Bakersfield, CA 93301-1713 | 2005-08-31 |
| 1386177293 | Amna Jehan Ara Ahmed Fareedy | General Practice | 7800 Niles St, Bakersfield, CA 93306-4922 | 2017-04-07 |
| Find all providers in BAKERSFIELD | ||||
| City | BAKERSFIELD |
| Zip Code | 93301 |
Please comment or provide details below to improve the information on SAN JOAQUIN WELLNESS & MEDICAL GROUP, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.