NPIMap

Organization Active NPI

Kaiser Permanente

  • Adolescent and Children Mental Health Clinic/Center
  • Vallejo, CA
National Provider Identifier
1881923456
Registry record updated Dec 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
25635 Issued in CA
Legal business name
KAISER PERMANENTE
Practice address
1761 Broadway St Ste 100
Vallejo, CA 94589-2227
Phone
(707) 645-2700
Fax
(707) 645-2181
NPI assigned
Dec 10, 2009
Last updated
Dec 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2009

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

Authorized official

Name
Mr. Roger Spence, LCSW
Title
Manager
Phone
(707) 645-2700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 25635 CA
Adolescent and Children Mental Health Clinic/Center 261QM0855X 25635 CA Primary

Addresses

Primary practice location

1761 Broadway St Ste 100
Vallejo, CA 94589-2227

Mailing address

1761 Broadway St Ste 100
Vallejo, CA 94589-2227
Phone (707) 645-2700

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260403200000",
    "number": "1881923456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 BROADWAY ST STE 100",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892227",
            "telephone_number": "707-645-2700",
            "fax_number": "707-645-2181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 BROADWAY ST STE 100",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892227",
            "telephone_number": "707-645-2700",
            "fax_number": "707-645-2181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER PERMANENTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2009-12-10",
        "status": "A",
        "authorized_official_last_name": "SPENCE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "707-645-2700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "25635",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CA",
            "license": "25635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; 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.