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General NPI Number Information
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NPI Number | 1568758100
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Entity Type | Individual
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Provider Name | KAUAI NICOLE KENNEDY-ETO M,D., MPH
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Gender | Female
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 1711 N. ORANGE STREET
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City | REDLANDS
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State | CA
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Zip | 92374-2254
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Country | US
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Telephone | 909-792-2200
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Fax | 909-792-2660
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Provider Business Mailing Address
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Address Line | 1711 N. ORANGE STREET
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City | REDLANDS
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State | CA
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Zip | 92374-2254
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Country | US
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Telephone | 909-792-2200
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Fax | 909-792-2660
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A127206
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A127206
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License Number State | CA
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