Basic Information
| Provider Information | |||||||||
| NPI: | 1679079560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEBER | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 DORCHESTER AVE # 3 | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021251251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123707622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2315 STOCKTON BLVD # OP512 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167342816 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2018 | ||||||||
| LastUpdateDate: | 04/01/2018 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.