Healthcare Provider Details

I. General information

NPI: 1871994541
Provider Name (Legal Business Name): KAYE RESURRECCION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

120 CHASE ST
VALLEJO CA
94590-7010
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-4756
  • Fax:
Mailing address:
  • Phone: 707-641-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00462387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: