1649305194 NPI number — MS. BEVERLY LENN RHODES A8390501

Table of content: MS. BEVERLY LENN RHODES A8390501 (NPI 1649305194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649305194 NPI number — MS. BEVERLY LENN RHODES A8390501

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHODES
Provider First Name:
BEVERLY
Provider Middle Name:
LENN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
A8390501
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RHODES
Provider Other First Name:
BEVERLY
Provider Other Middle Name:
LENN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
A8390501
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649305194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3218
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:
93385-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-246-3180
Provider Business Mailing Address Fax Number:
666-163-3991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3316 LAVERNE AVE
Provider Second Line Business Practice Location Address:
3316 LAVERNE AVENUE
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-4082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-832-8504
Provider Business Practice Location Address Fax Number:
661-827-9432
Provider Enumeration Date:
02/23/2007

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 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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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