MEDICARE: KENNETH LEONARD HARTMAN RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	16290	CA

General Provider Information

NPI Number	:	1053388124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH LEONARD HARTMAN RPA-C

Provider Business Mailing Address
First Line	:	2121 S TOWNE CENTRE PL
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-6122
Country	:	US
Telephone Number	:	714-937-1919
Fax Number	:	714-937-1095

Provider Business Practice Location Address
First Line	:	2121 S TOWNE CENTRE PL
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-6122
Country	:	US
Telephone Number	:	714-937-1919
Fax Number	:	714-937-1095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	02/25/2010

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