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Individual

DR. VINCENT JOSEPH MADDELA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2701 CHESTER AVE # 201, BAKERSFIELD, CA 93301-2016
(661) 716-1070
(661) 716-1075
Mailing address
2701 CHESTER AVE, BAKERSFIELD, CA 93301-2016
(661) 716-9422
(661) 323-0889

Taxonomy

Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
A53726
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
GR0092950
MEDI-CAL GROUP #
CA
01
ZZZ01707Z
MEDICARE GROUP #
CA
01
ZZZ01800Z
BLUE SHIELD GROUP PROV #
CA
Enumeration date
02/06/2007
Last updated
02/21/2013
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