1932756509 NPI number — KAYLEE ELIZABETH CARNEY GOTHELF

Table of content: KAYLEE ELIZABETH CARNEY GOTHELF (NPI 1932756509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932756509 NPI number — KAYLEE ELIZABETH CARNEY GOTHELF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOTHELF
Provider First Name:
KAYLEE
Provider Middle Name:
ELIZABETH CARNEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932756509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1940 FRANKLIN ST APT 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94109-3471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-472-6505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 OAK PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94523-4487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-935-5222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com