Basic Information
| Provider Information | |||||||||
| NPI: | 1306051131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUKTARASIRI | ||||||||
| FirstName: | KAEWCHAI | ||||||||
| MiddleName: | |||||||||
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| Credential: | F.N.P | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PUKTARASIRI | ||||||||
| OtherFirstName: | KITTY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 9602 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913469602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188375637 | ||||||||
| FaxNumber: | 8188375589 | ||||||||
| Practice Location | |||||||||
| Address1: | 25775 MCBEAN PKWY | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913553708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614248848 | ||||||||
| FaxNumber: | 6614248844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 10/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 10549 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LX0001X | NP10549 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.