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General NPI Number Information
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NPI Number | 1720825722
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Entity Type | Individual
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Provider Name | KENNETH KRUGER
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Gender | Male
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Dates
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Enumeration Date | 07/09/2024
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 82 TABLE MOUNTAIN BLVD
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City | OROVILLE
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State | CA
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Zip | 95965-3578
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Country | US
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Telephone | 530-538-7705
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33568
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City | SAN DIEGO
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State | CA
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Zip | 92163-3568
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Country | US
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Telephone | 855-223-7123
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Fax | 619-374-7134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | CA
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