Brian Waldman

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Avenal, CA

NPI 1295906014 · NPPES record last updated May 14, 2024

Key facts

NPI
1295906014
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
1 Kings Way
Avenal, CA 93204-9708
Phone
(559) 386-0587
NPI assigned
Mar 19, 2008
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Corrections and Rehabilitation-Headquarters Current
since May 19, 2024
Accepting new patients

Locations

1 Kings Way
Avenal, CA 93204
Phone (559) 386-0587

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

1 Kings Way
Avenal, CA 93204-9708

Mailing address

472 Roosevelt St
Coalinga, CA 93210-2253
Phone (909) 244-6209

Other providers in Avenal, CA

All providers in Avenal, CA · Student in an Organized Health Care Education/Training Program in California

Sources for this page

Verify at the official NPI Registry.