=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447465109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK F KAUFMAN, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39300 BOB HOPE DR BANNAN BLDG STE 1113
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-346-3851
-----------------------------------------------------
Fax | 760-568-4592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39300 BOB HOPE DR BANNAN BLDG STE 1113
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 760-568-4592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MARY GUAENLLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-346-3851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 00G136033
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------