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Kenneth Robert Daughters
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NPI Number Detailed Information
Provider Information:
| Name: | Kenneth Robert Daughters |
| Gender: | M |
| Provider License Number If Given: | A74865 |
NPI Information:
| NPI: | 1598764193 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 7/18/2005 |
| Last Update Date: | 8/18/2008 |
Provider Business Mailing Address:
| Address: | PO BOX 4219 Orange, CA 92863 |
| Phone Number: | 7145715000 |
| Fax Number: | 7145715055 |
Provider Business Practice Location Address:
| Address: | PEUBLO AT BATH ST. Santa Barbara, CA 93105 |
| Phone Number: | 8055697279 |
| Fax Number: | 8055698279 |
Provider Taxonomy:
| Primary: | 2085R0202X |
| Secondary (if any): | |
| State: | CA |
