Healthcare Provider Details

I. General information

NPI: 1154787620
Provider Name (Legal Business Name): KEVIN FAULKNER RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5611 MANGRUM DR
HUNTINGTON BEACH CA
92649-1759
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone: 714-235-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: