Healthcare Provider Details

I. General information

NPI: 1609031863
Provider Name (Legal Business Name): MR. HANS KRISTIAN ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 INDIANA ST
SAN FRANCISCO CA
94107-3406
US

IV. Provider business mailing address

122 MYRTLE AVE
COTATI CA
94931-4388
US

V. Phone/Fax

Practice location:
  • Phone: 415-282-9675
  • Fax:
Mailing address:
  • Phone: 707-235-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: