| Kaiser Permanente | |
|
111 Smith Ranch Road Kaiser Permanente San Rafael CA 94903 | |
| (415) 444-3522 | |
| (415) 491-3028 |
| Full Name | Kaiser Permanente |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 111 Smith Ranch Road, San Rafael, California |
| Authorized Official Name and Position | Virginia Pieters (PROVIDER ENROLLMENT ANALST) |
| Authorized Official Contact | 4154443522 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaiser Permanente 111 Smith Ranch Road Kaiser Permanente San Rafael CA 94903 Ph: (415) 444-3522 | Kaiser Permanente 111 Smith Ranch Road Kaiser Permanente San Rafael CA 94903 Ph: (415) 444-3522 |
| NPI Number | 1083002315 |
|---|---|
| Provider Enumeration Date | 01/09/2015 |
| Last Update Date | 01/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083002315 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | LCS14720 (California) | Primary |
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