1952638207 NPI number — CORINNE ROSE KOHLEN R.D.

Table of content: CORINNE ROSE KOHLEN R.D. (NPI 1952638207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952638207 NPI number — CORINNE ROSE KOHLEN R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHLEN
Provider First Name:
CORINNE
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952638207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 LOS CERROS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93405-1272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-441-2281
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 CASA ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93405-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-548-8585
Provider Business Practice Location Address Fax Number:
805-548-8589
Provider Enumeration Date:
11/06/2009

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133VN1005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1001966 . This is a "AMERICAN DIABETIC ASSOCIATION REGISTRATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 451935 . This is a "NAT'L KIDNEY FOUNDATION COUNCIL ON RENAL NUTRITION MEMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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