Provider Demographics
NPI:1053388124
Name:HARTMAN, KENNETH LEONARD (RPA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEONARD
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S TOWNE CENTRE PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6122
Mailing Address - Country:US
Mailing Address - Phone:714-937-1919
Mailing Address - Fax:714-937-1095
Practice Address - Street 1:2121 S TOWNE CENTRE PL
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6122
Practice Address - Country:US
Practice Address - Phone:714-937-1919
Practice Address - Fax:714-937-1095
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant