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General NPI Number Information
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NPI Number | 1821233974
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Entity Type | Organization
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Legal Business Name | KIMBERLY R FAUCHER MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 1155 SOUTH MAIN STREET
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City | WILLITS
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State | CA
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Zip | 95490-4336
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Country | US
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Telephone | 707-456-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 415 TALMAGE ROAD SUITE C
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City | UKIAH
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State | CA
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Zip | 95482-7486
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Country | US
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Telephone | 707-468-0609
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Fax | 707-468-0633
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Authorized Official
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Title or Position | OWNER/MD
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Name | KIMBERLY R FAUCHER
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Credential | MD
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Telephone | 707-456-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | G74987
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License Number State | CA
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