MEDICARE: MRS. KRISTINE H SAKET PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY20793	CA

General Provider Information

NPI Number	:	1730106808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINE H SAKET PHD

Provider Business Mailing Address
First Line	:	PO BOX 609001
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92160-9001
Country	:	US
Telephone Number	:	619-528-4600
Fax Number	:	619-528-4625

Provider Business Practice Location Address
First Line	:	1550 HOTEL CIRCLE NORTH
Second Line	:	STE 270
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2908
Country	:	US
Telephone Number	:	619-692-1581
Fax Number	:	619-528-4625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	01/15/2008

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