Provider Demographics
NPI:1801269063
Name:HENGEN, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:HENGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N MELROSE DR
Mailing Address - Street 2:#310
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-4981
Mailing Address - Country:US
Mailing Address - Phone:574-514-7023
Mailing Address - Fax:
Practice Address - Street 1:41421 DATE ST
Practice Address - Street 2:#101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7018
Practice Address - Country:US
Practice Address - Phone:855-454-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics