Individual ProviderJohn C HansenPediatricsAllopathic & Osteopathic PhysiciansPractice Address3030 Childrens Way, #112, San Diego, CA 92123(858) 495-0500(858) 636-4300PECOS EnrollmentBased on the most recent information from CMS, provider John C Hansen does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:29 PM.Profile DetailsProvider ID1780655621Provider TypeIndividualFull NameHansen, John CTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date1/30/2006Last Updated2/4/2011Contact InformationPractice LocationPractice Address3030 Childrens Way, #112, San Diego, CA 92123Phone(858) 495-0500Fax(858) 560-4279Mailing LocationMailing Address3860 Calle Fortunada, Ste 200, San Diego, CA 92123Phone(858) 636-4300Fax(858) 636-4319Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseG68382CaliforniaProvider IdentifiersIDDescriptionIssuerIDG68382DescriptionOtherIssuerMD LICENSECalifornia