1770958175 NPI number — KALEIGH MARIE BEHRENDT RN, PHN

Table of content: KALEIGH MARIE BEHRENDT RN, PHN (NPI 1770958175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770958175 NPI number — KALEIGH MARIE BEHRENDT RN, PHN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHRENDT
Provider First Name:
KALEIGH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, PHN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCLINTON
Provider Other First Name:
KALEIGH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, PHN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770958175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3851 ROSECRANS ST
Provider Second Line Business Mailing Address:
SUITE Y15
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92110-3115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-692-8435
Provider Business Mailing Address Fax Number:
858-715-6458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3851 ROSECRANS ST
Provider Second Line Business Practice Location Address:
SUITE Y15
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-692-8435
Provider Business Practice Location Address Fax Number:
858-715-6458
Provider Enumeration Date:
12/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  847500 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com