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General NPI Number Information
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NPI Number | 1538441332
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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 | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 3554 ROUND BARN BLVD
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City | SANTA ROSA
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State | CA
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Zip | 95403-0929
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Country | US
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Telephone | 707-571-3987
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Fax |
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Provider Business Mailing Address
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Address Line | 2480 VINEYARD RD
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City | NOVATO
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State | CA
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Zip | 94947-3601
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Country | US
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Telephone | 415-577-4018
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGY
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Name | DR. MORELLA E. BOMBARDINI
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Credential |
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Telephone | 415-577-4018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | PSY 24339
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License Number State | CA
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