Healthcare Provider Details

I. General information

NPI: 1447148754
Provider Name (Legal Business Name): KRISTEN TAYLOR HOUNSHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N BELLFLOWER BLVD
LONG BEACH CA
90840-0004
US

IV. Provider business mailing address

1658 MERRILL LOOP
SAN JOSE CA
95124-5812
US

V. Phone/Fax

Practice location:
  • Phone: 562-985-4111
  • Fax:
Mailing address:
  • Phone: 408-438-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: