1962676361 NPI number — DR. DOUGLAS TAYLOR KASLE PH.D

Table of content: DR. DOUGLAS TAYLOR KASLE PH.D (NPI 1962676361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962676361 NPI number — DR. DOUGLAS TAYLOR KASLE PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASLE
Provider First Name:
DOUGLAS
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROTHSTEIN
Provider Other First Name:
DOUGLAS
Provider Other Middle Name:
TAYLOR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962676361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 POTRERO ST
Provider Second Line Business Mailing Address:
UNIT 307
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95060-2741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-846-6401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1848 MCALLISTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94115-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-846-6401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008

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: 103TC0700X , with the licence number:  20824 , 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)