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General NPI Number Information
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NPI Number | 1083155022
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 1301 CALIFORNIA ST
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City | REDLANDS
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State | CA
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Zip | 92374-2910
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Country | US
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Telephone | 909-809-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 CALIFORNIA ST
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City | REDLANDS
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State | CA
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Zip | 92374-2910
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Country | US
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Telephone | 909-809-3110
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. FRANK AYALA JR.
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Credential | RPH
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Telephone | 909-809-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | RPH 39279
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License Number State | CA
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