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General NPI Number Information
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NPI Number | 1215382759
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Entity Type | Organization
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Legal Business Name | FLEMING INC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 23141 MOULTON PKWY SUITE 110
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1241
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Country | US
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Telephone | 949-916-5956
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Fax | 949-916-5993
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Provider Business Mailing Address
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Address Line | 23141 MOULTON PKWY SUITE 110
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1241
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Country | US
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Telephone | 949-916-5956
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Fax | 949-916-5993
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Authorized Official
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Title or Position | OWNER
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Name | KRISTY F FLEMING
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Credential | M.D.
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Telephone | 714-766-9822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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