Healthcare Provider Details

I. General information

NPI: 1881879781
Provider Name (Legal Business Name): ALICE WHITTLESEY KRAMER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 09/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 JACKSON ST
RIVERSIDE CA
92503-3919
US

IV. Provider business mailing address

7745 BOULDER AVE UNIT 1216
HIGHLAND CA
92346-8000
US

V. Phone/Fax

Practice location:
  • Phone: 909-534-4252
  • Fax:
Mailing address:
  • Phone: 909-534-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number19555
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: