Organization
JACK B KISTLER MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK BARTLETT KISTLER M.D. (PRESIDENT)
(951) 682-6263
Entity
Organization
Contact information
Practice address
6900 BROCKTON AVE STE 11, RIVERSIDE, CA 92506-3801
(951) 682-6263
(951) 682-0114
Mailing address
6900 BROCKTON AVE STE 11, RIVERSIDE, CA 92506-3801
(951) 682-6263
(951) 682-0114
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
C26186
CA
Other
Enumeration date
04/05/2010
Last updated
04/05/2010
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