Organization
BAKERSFIELD PATHOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILIBETH GUINTO-MIRANDA MD (PRESIDENT)
(661) 316-3000
Entity
Organization
Contact information
Practice address
3001 SILLECT AVE, BAKERSFIELD, CA 93308-6337
(661) 316-3000
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0092490
DHS GROUP ID
CA
01
—
ZZZ16224Z
BLUE SHIELD GROUP ID
CA
Enumeration date
03/17/2006
Last updated
11/20/2012
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