Provider Demographics
NPI:1003933383
Name:KAISER PERMANENTE
Entity Type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:KAISER PERMANENTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRE TOR OF FOOD AND NUTRITION
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:818-375-3686
Mailing Address - Street 1:6423 W ROSAMOND BLVD
Mailing Address - Street 2:PO BOX 1043
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560
Mailing Address - Country:US
Mailing Address - Phone:818-375-3484
Mailing Address - Fax:818-375-3644
Practice Address - Street 1:6423 W ROSAMOND BLVD
Practice Address - Street 2:
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560
Practice Address - Country:US
Practice Address - Phone:818-375-3484
Practice Address - Fax:818-375-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherSOCIAL SECURITY NO.