Healthcare Provider Details

I. General information

NPI: 1861547861
Provider Name (Legal Business Name): KATHLEEN HOBSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15229 AMAR RD
LA PUENTE CA
91744-2066
US

IV. Provider business mailing address

4417 SALISBURY DR
CARLSBAD CA
92010-2867
US

V. Phone/Fax

Practice location:
  • Phone: 626-855-5090
  • Fax: 626-961-1810
Mailing address:
  • Phone: 760-434-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number305411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: