Individual
KEVIN DARYL HAZEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15373 INNOVATION DR STE 220, SAN DIEGO, CA 92128-3425
(858) 592-8855
Mailing address
724 DENNIS AVE, CHULA VISTA, CA 91910-6215
(619) 762-0610
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
51342
CA
Other
Enumeration date
11/20/2021
Last updated
11/20/2021
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