Provider Information for 1457533630
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CHAD E KIEDROWSKI
Sex: Male
NPI: 1457533630
Last Updated: 2019-03-11
Certification Date:
Certification Date:
Details
Name | Value | ||||||||||||
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NPI | 1457533630 | ||||||||||||
Enumeration Date | 2007-11-29 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 10776 FREMONT ST YUCAIPA, CA 92399-9630 United States Phone: 951-797-0114 | Fax: | ||||||||||||
Primary Practice Address | 10776 FREMONT ST YUCAIPA, CA 92399-9630 United States Phone: 951-797-0114 | Fax: | ||||||||||||
Secondary Practice Address(es) | 4000 ORANGE ST | ||||||||||||
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