Kaiser Permanente

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

MFC17474 Issued in CA

Legal business name

KAISER PERMANENTE

Practice address

12815 Heacock St
Moreno Valley, CA 92553-3116

Phone

(051) 601-6174

Fax

(951) 601-6224

NPI assigned

Jun 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Roger Jackson Melton, L.M.F.T.

Title

Counselor III

Phone

(951) 601-6171

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265639660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12815 HEACOCK ST",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533116",
            "telephone_number": "051-601-6174",
            "fax_number": "951-601-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12815 HEACOCK ST",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533116",
            "telephone_number": "051-601-6174",
            "fax_number": "951-601-6224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER PERMANENTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MELTON",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "JACKSON",
        "authorized_official_title_or_position": "COUNSELOR III",
        "authorized_official_telephone_number": "951-601-6171",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.M.F.T."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "MFC17474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaiser Foundation Health Plan Inc
• Kaiser Foundation Hospitals
• Kaiser Foundation Hospitals
• Kaiser Foundation Hospitals
• Kaiser Foundation Hospitals
• Kaitlyn Phuc Thuan Nguyen, DDS, Inc
• Stephen S Kallaos, DDS
• Jason Michael Kamath, DO
• Ilho Kang, M.D.
• Dhaval Mahesh Kapadia, M.D.

• All providers in Moreno Valley, CA
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.