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General NPI Number Information
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NPI Number | 1477018653
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Entity Type | Individual
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Provider Name | DUSTIN WINSTON KILPATRICK
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Gender | Male
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 16250 SAND CANYON AVE
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City | IRVINE
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State | CA
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Zip | 92618-3714
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Country | US
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Telephone | 949-727-5016
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Fax |
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Provider Business Mailing Address
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Address Line | 605 CALLE FIERROS
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3034
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Country | US
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Telephone | 559-284-9106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 157364
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License Number State |
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