Healthcare Provider Details

I. General information

NPI: 1891576567
Provider Name (Legal Business Name): KLC HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24953 PASEO DE VALENCIA STE 1C
LAGUNA HILLS CA
92653-4337
US

IV. Provider business mailing address

24953 PASEO DE VALENCIA STE 1C
LAGUNA HILLS CA
92653-4337
US

V. Phone/Fax

Practice location:
  • Phone: 714-756-6756
  • Fax:
Mailing address:
  • Phone: 714-756-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LOU PESCE
Title or Position: CEO
Credential: CAADC 3
Phone: 714-756-6756