Healthcare Provider Details

I. General information

NPI: 1841595485
Provider Name (Legal Business Name): KATHLEEN KRUEGER HHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 S EL CAMINO REAL STE B4
SAN CLEMENTE CA
92672-4272
US

IV. Provider business mailing address

616 S EL CAMINO REAL STE B4
SAN CLEMENTE CA
92672-4272
US

V. Phone/Fax

Practice location:
  • Phone: 949-498-0120
  • Fax:
Mailing address:
  • Phone: 949-498-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5457
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number5457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: