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General NPI Number Information
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NPI Number | 1407249139
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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 | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 13748 HEATHERWOOD DR
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City | EASTVALE
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State | CA
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Zip | 92880-0713
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Country | US
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Telephone | 402-318-4165
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Fax |
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Provider Business Mailing Address
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Address Line | 13748 HEATHERWOOD DR
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City | EASTVALE
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State | CA
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Zip | 92880-0713
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Country | US
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Telephone | 402-318-4165
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MRS. ANGELA RENEE DAVIS
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Credential | RN
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Telephone | 402-318-4165
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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 | RN.0182309
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License Number State | CO
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