Healthcare Provider Details

I. General information

NPI: 1184973836
Provider Name (Legal Business Name): KP1 AND 2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BRUCE ST
YREKA CA
96097-3450
US

IV. Provider business mailing address

PO BOX 16102
SAN DIEGO CA
92176-6102
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-4121
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA70333
License Number StateCA

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS MGR
Credential:
Phone: 702-453-3799