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General NPI Number Information
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NPI Number | 1912025958
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Entity Type | Organization
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Legal Business Name | ERIC R. HANSEN, D.O., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 14575 MAIN ST
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City | HESPERIA
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State | CA
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Zip | 92345-3322
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Country | US
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Telephone | 760-948-8470
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Fax | 760-947-6219
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Provider Business Mailing Address
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Address Line | 14575 MAIN ST
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City | HESPERIA
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State | CA
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Zip | 92345-3322
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Country | US
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Telephone | 760-948-8470
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Fax | 760-947-6219
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Authorized Official
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Title or Position | C.E.O.
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Name | ERIC R HANSEN
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Credential | D.O.
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Telephone | 760-948-8470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A8138
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License Number State | CA
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