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General NPI Number Information
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NPI Number | 1912258997
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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 | 10/01/2012
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 710 LAWRENCE EXPY DEPT. 182
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City | SANTA CLARA
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State | CA
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Zip | 95051-5173
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Country | US
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Telephone | 408-851-3805
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Fax |
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Provider Business Mailing Address
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Address Line | 7274 ALDER SPRING WAY
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City | SAN JOSE
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State | CA
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Zip | 95139-1303
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Country | US
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Telephone | 408-821-7741
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MR. PABLO GUTIERREZ
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Credential | R.D.
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Telephone | 408-821-7741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1038721
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License Number State | CA
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