Provider Demographics
NPI:1801983150
Name:KAISER PERMANENTE VALLEJO
Entity type:Organization
Organization Name:KAISER PERMANENTE VALLEJO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLIN-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-651-4790
Mailing Address - Street 1:1764 STUART CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1731
Mailing Address - Country:US
Mailing Address - Phone:707-746-1339
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-2906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN276380282N00000X, 261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No282N00000XHospitalsGeneral Acute Care Hospital