Provider Demographics
NPI:1689778755
Name:COMER, KATHLEEN FRANCES (MSN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:COMER
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:COMER-PUIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5887 BROCKTON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1858
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:5549 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2068
Practice Address - Country:US
Practice Address - Phone:951-324-5901
Practice Address - Fax:877-778-9472
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11406363L00000X
CANP11406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01363669OtherRAILROAD MEDICARE- DU4034
CAP01363669OtherRAILROAD MEDICARE- DU4034
P96881Medicare UPIN