1124149901 NPI number — MS. ROSANDA JENAY ANDERSON RAS

Table of content: MS. ROSANDA JENAY ANDERSON RAS (NPI 1124149901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124149901 NPI number — MS. ROSANDA JENAY ANDERSON RAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
ROSANDA
Provider Middle Name:
JENAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRIDGEFORTH
Provider Other First Name:
ROSANDA
Provider Other Middle Name:
JENAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124149901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1926 STILLMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93304-4945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-396-9797
Provider Business Mailing Address Fax Number:
661-396-9998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93304-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-631-8415
Provider Business Practice Location Address Fax Number:
661-326-1602
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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