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General NPI Number Information
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NPI Number | 1326653999
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Entity Type | Organization
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Legal Business Name | PUMPHREY PATCH KIDZ, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 29798 HAUN RD STE 304
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City | MENIFEE
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State | CA
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Zip | 92586-6542
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Country | US
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Telephone | 951-679-3159
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Fax | 951-679-0250
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Provider Business Mailing Address
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Address Line | 29798 HAUN RD STE 304
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City | MENIFEE
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State | CA
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Zip | 92586-6542
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Country | US
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Telephone | 951-679-3159
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Fax | 951-679-0250
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Authorized Official
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Title or Position | MANAGER
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Name | KATHRYN SPAAN
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Credential |
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Telephone | 951-679-3159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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