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NPI Code Detail

MEDICARE: KEVIN KLATT HHP

MEDICARE: KEVIN KLATT HHP
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
1225700000XMassage Therapist36062CA

General Provider Information

NPI Number : 1669608840
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN KLATT HHP
Provider Business Mailing Address
First Line : 3639 MIDWAY DR
Second Line : SUITE B307
City : SAN DIEGO
State : CA
Zip : 92110-5254
Country : US
Telephone Number : 619-994-6172
Fax Number :
Provider Business Practice Location Address
First Line : 4010 SORRENTO VALLEY BLVD
Second Line : SUITE 300
City : SAN DIEGO
State : CA
Zip : 92121-1432
Country : US
Telephone Number : 858-678-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2009
Last Update Date : 06/02/2009

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