Healthcare Provider Details

I. General information

NPI: 1689778755
Provider Name (Legal Business Name): KATHLEEN FRANCES COMER MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN COMER-PUIG

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5549 VAN BUREN BLVD
RIVERSIDE CA
92503-2068
US

IV. Provider business mailing address

5887 BROCKTON AVE STE A
RIVERSIDE CA
92506-1858
US

V. Phone/Fax

Practice location:
  • Phone: 951-324-5901
  • Fax: 877-778-9472
Mailing address:
  • Phone: 562-499-6191
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11406
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP11406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: