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General NPI Number Information
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NPI Number | 1629272026
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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 | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5105 W GOLDLEAF CIR
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City | LOS ANGELES
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State | CA
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Zip | 90056-1269
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Country | US
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Telephone | 323-298-3100
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Fax | 323-298-3119
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Provider Business Mailing Address
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Address Line | 10876 MARIETTA AVE
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City | CULVER CITY
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State | CA
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Zip | 90232-3714
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Country | US
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Telephone | 310-836-7195
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOTHERAPIST
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Name | MR. WALTER JOSEPH DELORRELL JR.
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Credential | MFT
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Telephone | 323-298-3100
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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 | MFC 29835
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License Number State | CA
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