MEDICARE: KAREN J POMPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		CA

General Provider Information

NPI Number	:	1609477629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN J POMPA

Provider Business Mailing Address
First Line	:	2605 E DATE PALM PASEO APT 2194
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-4670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 E DATE PALM PASEO APT 2194
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-4670
Country	:	US
Telephone Number	:	323-476-8906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	11/05/2020

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