Provider Demographics
NPI:1881846061
Name:RICH, KIEFER
Entity Type:Individual
Prefix:MR
First Name:KIEFER
Middle Name:
Last Name:RICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 ADAMS AVE
Mailing Address - Street 2:UNIT 161257
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92176-7001
Mailing Address - Country:US
Mailing Address - Phone:619-752-4666
Mailing Address - Fax:619-327-4110
Practice Address - Street 1:3636 5TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4281
Practice Address - Country:US
Practice Address - Phone:619-997-4699
Practice Address - Fax:619-327-4110
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist