Individual
KIMBERLY STACIE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
13400 PIPELINE AVE, CHINO, CA 91710-4959
(909) 591-3902
Mailing address
2712 S MONTEGO APT F, ONTARIO, CA 91761-0438
(909) 947-3731
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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