Healthcare Provider Details

I. General information

NPI: 1568504587
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 N 1ST ST
FRESNO CA
93726-0513
US

IV. Provider business mailing address

8296 N DEL MAR AVE
FRESNO CA
93711-6017
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4555
  • Fax:
Mailing address:
  • Phone: 559-439-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number500381
License Number StateCA

VIII. Authorized Official

Name: MS. LORI L. SMITH
Title or Position: STAFF NURSE II
Credential: RN
Phone: 559-448-5410