Healthcare Provider Details

I. General information

NPI: 1902386790
Provider Name (Legal Business Name): KALYN MERCEDES BEDEL IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34101 FARENHOLT AVE
SAN DIEGO CA
92134-7000
US

IV. Provider business mailing address

30201 E 37TH ST
YUMA AZ
85365
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7968
  • Fax:
Mailing address:
  • Phone: 909-533-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: