Healthcare Provider Details

I. General information

NPI: 1174352660
Provider Name (Legal Business Name): KAITLYN RAYANN CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12718 BRIDGEWATER DR
EASTVALE CA
92880-8847
US

IV. Provider business mailing address

12718 BRIDGEWATER DR
EASTVALE CA
92880-8847
US

V. Phone/Fax

Practice location:
  • Phone: 951-502-4413
  • Fax:
Mailing address:
  • Phone: 951-502-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: