Ketamine Ca PC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

KETAMINE CA PC

Practice address

6313 Schirra CT Ste 1a
Bakersfield, CA 93313-2174

Phone

(602) 790-3744

NPI assigned

Nov 27, 2018

Last updated

Jan 3, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Challen Waychoff

Title

Coo

Phone

(602) 344-9850

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546473600000",
    "number": "1598235012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3724 N 3RD ST STE 201",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122034",
            "telephone_number": "602-344-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6313 SCHIRRA CT STE 1A",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933132174",
            "telephone_number": "602-790-3744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE CA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-27",
        "last_updated": "2019-01-03",
        "status": "A",
        "authorized_official_last_name": "WAYCHOFF",
        "authorized_official_first_name": "CHALLEN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "602-344-9850"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blake Kerr, CSWII MSW
• Nicole Carolyn Kerr, C.O
• Salina Regina Kerr
• Candace R Kerwin, LCSW
• Brett V Kesler, D.P.M.
• Kevin D. Trinh, MD and John L. Brazill, MD, a Medical Corp. (Bakersfield Pain Management, Inc.)
• Kevin Holiwell O.D.,Aoc
• Kevin Kobliska DMD Inc
• Kevork Bouldoukian, M.D., Inc.
• My Kha, M.D.

• Infusion Therapy Clinic/Center in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Infusion Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.