Healthcare Provider Details

I. General information

NPI: 1588198402
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9945 VALGRANDE WAY
ELK GROVE CA
95757-3004
US

IV. Provider business mailing address

9945 VALGRANDE WAY
ELK GROVE CA
95757-3004
US

V. Phone/Fax

Practice location:
  • Phone: 916-296-3512
  • Fax:
Mailing address:
  • Phone: 916-296-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberRPH54607
License Number StateCA

VIII. Authorized Official

Name: ANJANA PATEL
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 916-296-3512