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KAISER PERMANENTE NPI 1922337864


NPI Information

NPI: 1922337864
Provider Name: KAISER PERMANENTE
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

Address:
1761 BROADWAY ST
100
VALLEJO, CA
ZIP 94589
Phone: (707) 645-2700
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KAISER PERMANENTE is an adolescent and children mental health clinic center in Vallejo, CA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. KAISER PERMANENTE NPI is 1922337864. The provider is registered as an organization entity type.

The provider's business location address is:

1761 BROADWAY ST
100
VALLEJO, CA
ZIP 94589-226
Phone: (707) 645-2700
Fax: (707) 645-2181

The provider's authorized official is Tracie Lee Kepler Hoffman .
The authorized official title is Mft and has the following contact phone number (707) 645-2700.

The enumeration date for this NPI number is 12/23/2009 and was last updated on 12/23/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0850XClinic/CenterAdult Mental HealthMFC 47228CALIFORNIANo
2261QM0855XClinic/CenterAdolescent and Children Mental HealthMFC 47228CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========MEDICAIDCALIFORNIA
20=========MEDICARE NSCCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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