Provider Demographics
NPI:1407395528
Name:KLP MEDICAL
Entity Type:Organization
Organization Name:KLP MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLICK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:949-939-1135
Mailing Address - Street 1:1508 CALLE SACRAMENTO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4913
Mailing Address - Country:US
Mailing Address - Phone:949-939-1135
Mailing Address - Fax:
Practice Address - Street 1:1508 CALLE SACRAMENTO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4913
Practice Address - Country:US
Practice Address - Phone:949-939-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14902363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty