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General NPI Number Information
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NPI Number | 1316597230
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Entity Type | Organization
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Legal Business Name | K-CLEAR NURSING INC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 1822 SPRINGGATE LN UNIT G.
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City | SIMI VALLEY
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State | CA
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Zip | 93065
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Country | US
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Telephone | 805-813-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 SPRINGGATE LN UNIT G.
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City | SIMI VALLEY
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State | CA
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Zip | 93065
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Country | US
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Telephone | 805-813-7979
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. KLAR FULGENTES PASILABAN
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Credential | NP
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Telephone | 805-813-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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