Organization
PROVIDENCE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW TATE PA-C (PHYSICIAN ASSISTANT)
(805) 748-1687
Entity
Organization
Contact information
Practice address
1806 WADSWORTH AVENUE, BAKERSFIELD, CA 93311
(805) 748-1687
Mailing address
1806 WADSWORTH AVENUE, BAKERSFIELD, CA 93311
(805) 748-1687
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
PA19685
CA
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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