Provider Demographics
NPI:1124988753
Name:KALEIDACARE HEALTH AND WELLNESS PHYSICIAN ASSISTANT INC.
Entity type:Organization
Organization Name:KALEIDACARE HEALTH AND WELLNESS PHYSICIAN ASSISTANT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-570-1137
Mailing Address - Street 1:586 MANZANA PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-7811
Mailing Address - Country:US
Mailing Address - Phone:480-570-1137
Mailing Address - Fax:
Practice Address - Street 1:586 MANZANA PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-7811
Practice Address - Country:US
Practice Address - Phone:480-570-1137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-15
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty