Provider Demographics
NPI:1538441332
Name:KAISER PERMANENTE
Entity type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MORELLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOMBARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-577-4018
Mailing Address - Street 1:2480 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3601
Mailing Address - Country:US
Mailing Address - Phone:415-577-4018
Mailing Address - Fax:
Practice Address - Street 1:3554 ROUND BARN BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0929
Practice Address - Country:US
Practice Address - Phone:707-571-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24339283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital