Individual
KRISTIN MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
585 N MOUNTAIN AVE, SUITE A, UPLAND, CA 91786-8516
(909) 946-2228
(909) 946-8007
Mailing address
840 TOWNE CENTER DR, POMONA, CA 91767-5900
(909) 398-1550
(909) 398-1573
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/11/2015
Last updated
10/22/2015
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