Healthcare Provider Details

I. General information

NPI: 1083241905
Provider Name (Legal Business Name): KERRI KRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/27/2025
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S BRISTOL ST
SANTA ANA CA
92704-6201
US

IV. Provider business mailing address

890 W STETSON AVE STE B
HEMET CA
92543-7311
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-5454
  • Fax:
Mailing address:
  • Phone: 714-953-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA184163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: