Healthcare Provider Details

I. General information

NPI: 1952221004
Provider Name (Legal Business Name): JUSTIN R HANSEN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 EL CAJON BLVD
SAN DIEGO CA
92104-1096
US

IV. Provider business mailing address

9231 LAKE HILL RD
SANTEE CA
92071-2152
US

V. Phone/Fax

Practice location:
  • Phone: 619-817-0772
  • Fax:
Mailing address:
  • Phone: 760-473-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number28063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: