Healthcare Provider Details

I. General information

NPI: 1801983150
Provider Name (Legal Business Name): KAISER PERMANENTE VALLEJO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

1764 STUART CT
BENICIA CA
94510-1731
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2906
  • Fax:
Mailing address:
  • Phone: 707-746-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberRN276380
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberRN276380
License Number StateCA

VIII. Authorized Official

Name: CAMILE APPLIN-JONES
Title or Position: SERVICE DIRECTOR
Credential:
Phone: 707-651-4790