MEDICARE: DR. COLLEEN A KRAFT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G47936	CA
2	208000000X	Pediatrics Physician	35.123129	OH

General Provider Information

NPI Number	:	1487761631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN A KRAFT MD

Provider Business Mailing Address
First Line	:	2075 SAN JOAQUIN HILLS RD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6505
Country	:	US
Telephone Number	:	949-760-9222
Fax Number	:	949-629-3509

Provider Business Practice Location Address
First Line	:	2075 SAN JOAQUIN HILLS RD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6505
Country	:	US
Telephone Number	:	949-760-9222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	09/12/2019

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