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General NPI Number Information
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NPI Number | 1093911620
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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 | 06/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9449 IMPERIAL HWY PM&R GARDEN 4TH FL
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City | DOWNEY
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State | CA
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Zip | 90242-2814
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Country | US
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Telephone | 562-657-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 3075 NIGHTWIND CIR
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City | CORONA
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State | CA
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Zip | 92882-6061
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Country | US
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Telephone | 909-234-5699
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LISA P DOW
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Credential | PH.D.
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Telephone | 562-657-2860
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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 | PSY16520
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License Number State | CA
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