Healthcare Provider Details

I. General information

NPI: 1265637599
Provider Name (Legal Business Name): LORELEI M KINCAID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CABRILLO PARK DR STE 100
SANTA ANA CA
92701-5016
US

IV. Provider business mailing address

24 HAMMOND STE C
IRVINE CA
92618-1680
US

V. Phone/Fax

Practice location:
  • Phone: 714-571-0141
  • Fax: 714-543-4787
Mailing address:
  • Phone: 949-770-6022
  • Fax: 949-770-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: