Individual
MR. KEVIN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, ATC
Contact information
Practice address
5151 PACIFIC AVE, STOCKTON, CA 95207-6370
(209) 954-5181
Mailing address
5151 PACIFIC AVE, STOCKTON, CA 95207-6370
(209) 954-5181
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
12/05/2009
Last updated
09/02/2019
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