Provider Demographics
NPI:1811623036
Name:IGLESIAS, KEVIN JOSE
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSE
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7265 SHOUP AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1735
Mailing Address - Country:US
Mailing Address - Phone:818-223-1026
Mailing Address - Fax:
Practice Address - Street 1:15302 RAYEN ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5118
Practice Address - Country:US
Practice Address - Phone:818-892-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker