Jack B Kistler MD Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

C26186 Issued in CA

Legal business name

JACK B KISTLER MD INC

Practice address

6900 Brockton Ave Ste 11
Riverside, CA 92506-3801

Phone

(951) 682-6263

Fax

(951) 682-0114

NPI assigned

Apr 5, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Jack Bartlett Kistler, M.D.

Title

President

Phone

(951) 682-6263

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samer S Sannoufi, MD

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1528023264
  NPD (past)

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

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270425600000",
    "number": "1457676249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 11",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063801",
            "telephone_number": "951-682-6263",
            "fax_number": "951-682-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 11",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063801",
            "telephone_number": "951-682-6263",
            "fax_number": "951-682-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK B KISTLER MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-05",
        "last_updated": "2010-04-05",
        "status": "A",
        "authorized_official_last_name": "KISTLER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "BARTLETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-682-6263",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "C26186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Izarraras-Cesar
• Samantha Izquierdo
• J & L Love and Care Senior Living LLC
• J Watts Office Inc
• Ranj Jaaf
• Jack H. Akmakjian, MD Inc.
• Rebecca Lynn Jack, ATC
• Jacknolia Urgent Care
• John Arimon Jackop Eshak, RPH
• Aeisha Jackson

• Primary Care Clinic/Center in Riverside, CA
• Providers in Riverside, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; 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.