Healthcare Provider Details

I. General information

NPI: 1902460793
Provider Name (Legal Business Name): AUBREE KERTSON MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 KENORA DR
SPRING VALLEY CA
91977-2926
US

IV. Provider business mailing address

3602 KENORA DR
SPRING VALLEY CA
91977-2926
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-8875
  • Fax:
Mailing address:
  • Phone: 619-463-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: