| Organization Name: | COVENANT COMMUNITY MEDICAL GROUP, INC. |
| NPI Number: | 1942519558 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ARTNEY MICHELLE JACKSON (OFFICE MANAGER) |
| Mailing Address: | 3803 Union Ave Bakersfield |
| State: | CA US |
| Postal Code: | 933052400 |
| Phone Number: | 6613219206 |
| Fax Number: | 6613210932 |
| NPI Enumeration Date: | 09/29/2010 |
| NPI Last Update Date: | 02/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G41041 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |