MEDICARE: MR. KEVIN MICHAEL PARHAM

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	175T00000X	Peer Specialist	MPSS-TRQZHP	CA
2	246Z00000X	Other Specialist/Technologist	MPSS-TRQZHP	CA

General Provider Information

NPI Number	:	1831886647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN MICHAEL PARHAM

Provider Business Mailing Address
First Line	:	1660 HOTEL CIR N STE 101&314
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2807
Country	:	US
Telephone Number	:	619-961-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 HOTEL CIR N STE 101&314
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2807
Country	:	US
Telephone Number	:	619-961-2120
Fax Number	:

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

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	03/16/2026

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