Organization
KIC 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONNY DIAZ (ADMINISTRATOR)
(480) 874-7012
Entity
Organization
Contact information
Practice address
6313 SCHIRRA CT STE A1, BAKERSFIELD, CA 93313-2191
(480) 331-4222
Mailing address
3724 N 3RD ST # 201, PHOENIX, AZ 85012-2034
(602) 344-9850
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
09/18/2019
Last updated
02/18/2020
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