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Individual

KATHLEEN HANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD, CDE

Contact information

Practice address
815 BAY AVE, SUITE B, CAPITOLA, CA 95010-2186
(831) 460-7333
Mailing address
815 BAY AVE, CAPITOLA, CA 95010-2186
(831) 458-5621

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
966355
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ED933Z
MEDICARE PPIN
CA
Enumeration date
10/01/2010
Last updated
02/27/2014
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