Provider Demographics
NPI:1699777896
Name:COMELLI, RUBEN PEDRO (MD)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:PEDRO
Last Name:COMELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 CALIFORNIA AVE
Mailing Address - Street 2:400B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7081
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:277 EAST FRONT STRRET
Practice Address - Street 2:
Practice Address - City:BUTTONWILLOW
Practice Address - State:CA
Practice Address - Zip Code:93206-0917
Practice Address - Country:US
Practice Address - Phone:661-459-1900
Practice Address - Fax:661-459-1974
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50201207Q00000X
CA50201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51601Medicare UPIN
A51601Medicare UPIN