Provider Demographics
NPI:1841595485
Name:KRUEGER, KATHLEEN (HHP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S EL CAMINO REAL STE B4
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4272
Mailing Address - Country:US
Mailing Address - Phone:949-498-0120
Mailing Address - Fax:
Practice Address - Street 1:616 S EL CAMINO REAL STE B4
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4272
Practice Address - Country:US
Practice Address - Phone:949-498-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5457172M00000X, 225700000X
374J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No374J00000XNursing Service Related ProvidersDoula
No374U00000XNursing Service Related ProvidersHome Health Aide