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General NPI Number Information
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NPI Number | 1104476480
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Entity Type | Organization
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Legal Business Name | KIC 2
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 6313 SCHIRRA CT STE A1
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City | BAKERSFIELD
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State | CA
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Zip | 93313-2191
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Country | US
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Telephone | 480-331-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 3724 N 3RD ST # 201
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City | PHOENIX
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State | AZ
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Zip | 85012-2034
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Country | US
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Telephone | 602-344-9850
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SONNY DIAZ
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Credential |
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Telephone | 480-874-7012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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