Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A68013 | CA |
NPI | 1184791055 |
---|---|
Provider Name | Jennifer Black |
First Address | Bakersfield, CA 93301-1407 |
Second Address | Bakersfield, CA 93301-1407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 04/02/2022 |