Healthcare Provider Details

I. General information

NPI: 1467500298
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 VACA VALLEY PKWY FL 2
VACAVILLE CA
95688-9430
US

IV. Provider business mailing address

3700 VACA VALLEY PKWY FL 2
VACAVILLE CA
95688-9430
US

V. Phone/Fax

Practice location:
  • Phone: 707-453-5202
  • Fax: 707-453-2959
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46045
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALBERT CARVER
Title or Position: VP PHRMCY STRATEGY OPERATIONS
Credential:
Phone: 562-658-3510