| Lac Medical, Inc | |
|
9330 Stockdale Hwy Suite 200 Bakersfield CA 93311-3614 | |
| (661) 573-9400 | |
| Not Available |
| Full Name | Lac Medical, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 9330 Stockdale Hwy, Bakersfield, California |
| Authorized Official Name and Position | Luis A Cousin (OWNER) |
| Authorized Official Contact | 6613271431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lac Medical, Inc Po Box 21206 Bakersfield CA 93390-1206 Ph: (661) 573-9400 | Lac Medical, Inc 9330 Stockdale Hwy Suite 200 Bakersfield CA 93311-3614 Ph: (661) 573-9400 |
| NPI Number | 1366992919 |
|---|---|
| Provider Enumeration Date | 10/06/2016 |
| Last Update Date | 10/09/2016 |
| Medicare PECOS PAC ID | 5294017703 |
|---|---|
| Medicare Enrollment ID | O20170118000835 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366992919 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G52726 (California) | Primary |
| Provider Name | Julie Christine Pruett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639587579 PECOS PAC ID: 5294778262 Enrollment ID: I20050609001156 |
| Provider Name | John J Fosbinder |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619956976 PECOS PAC ID: 9537050687 Enrollment ID: I20051025000944 |
| Provider Name | Luis Cousin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477664936 PECOS PAC ID: 3870595085 Enrollment ID: I20081222000129 |
| Provider Name | Mary N Milkie-andrews |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336271832 PECOS PAC ID: 3375729908 Enrollment ID: I20110517000300 |
| Provider Name | Rocio Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396053369 PECOS PAC ID: 0941438303 Enrollment ID: I20140109000502 |
| Provider Name | Idalberto Zaldivar Galves |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407332919 PECOS PAC ID: 6901215029 Enrollment ID: I20210430002184 |
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