Provider Demographics
NPI:1235636259
Name:KAYDEE WELCHONS
Entity type:Organization
Organization Name:KAYDEE WELCHONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCHONS
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:760-845-0300
Mailing Address - Street 1:1654 ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1006
Mailing Address - Country:US
Mailing Address - Phone:760-845-0300
Mailing Address - Fax:
Practice Address - Street 1:811 W SAN MARCOS BLVD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1112
Practice Address - Country:US
Practice Address - Phone:760-845-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center