Healthcare Provider Details

I. General information

NPI: 1134815442
Provider Name (Legal Business Name): KATHLEEN D KLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 CRESTON RD
PASO ROBLES CA
93446-3031
US

IV. Provider business mailing address

5770 FAROUSSE WAY
PASO ROBLES CA
93446-9273
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-3028
  • Fax: 805-239-4924
Mailing address:
  • Phone: 805-423-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number36355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: