Provider Demographics
NPI:1710422126
Name:KALFELL, PAUL (PNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KALFELL
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CORNICHE DR UNIT H
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4023
Mailing Address - Country:US
Mailing Address - Phone:949-922-0574
Mailing Address - Fax:
Practice Address - Street 1:41820 GARSTIN DRIVE
Practice Address - Street 2:BOX 1649
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-878-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11123363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics