Provider Demographics
NPI:1447465109
Name:MARK F KAUFMAN, MD INC
Entity type:Organization
Organization Name:MARK F KAUFMAN, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAENLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-346-3851
Mailing Address - Street 1:39300 BOB HOPE DR
Mailing Address - Street 2:BANNAN BLDG STE 1113
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:760-568-4592
Practice Address - Street 1:39300 BOB HOPE DR
Practice Address - Street 2:BANNAN BLDG STE 1113
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3203
Practice Address - Country:US
Practice Address - Phone:760-346-3851
Practice Address - Fax:760-568-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G136033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39034Medicare UPIN