Healthcare Provider Details

I. General information

NPI: 1669608840
Provider Name (Legal Business Name): KEVIN KLATT HHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 SORRENTO VALLEY BLVD SUITE 300
SAN DIEGO CA
92121-1432
US

IV. Provider business mailing address

3639 MIDWAY DR SUITE B307
SAN DIEGO CA
92110-5254
US

V. Phone/Fax

Practice location:
  • Phone: 858-678-0300
  • Fax:
Mailing address:
  • Phone: 619-994-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number36062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: