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General NPI Number Information
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NPI Number | 1942559455
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Entity Type | Organization
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Legal Business Name | BECKY KROLL, MD, INC.
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 18181 BUTTERFIELD BLVD SUITE 180
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City | MORGAN HILL
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State | CA
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Zip | 95037-8112
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Country | US
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Telephone | 408-779-7696
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Fax | 408-779-5546
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Provider Business Mailing Address
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Address Line | 18181 BUTTERFIELD BLVD SUITE 180
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City | MORGAN HILL
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State | CA
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Zip | 95037-8112
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Country | US
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Telephone | 408-779-7696
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Fax | 408-779-5546
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Authorized Official
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Title or Position | PRESIDENT
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Name | BECKY S KROLL
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Credential | MD
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Telephone | 408-779-7696
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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 | A112974
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License Number State | CA
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