MEDICARE: KRISTINA E WASHBURN PA

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	363A00000X	Physician Assistant	57719	CA

General Provider Information

NPI Number	:	1780227926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA E WASHBURN PA

Provider Business Mailing Address
First Line	:	360 SAN MIGUEL DR STE 107
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7815
Country	:	US
Telephone Number	:	949-760-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 107
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7815
Country	:	US
Telephone Number	:	949-760-8300
Fax Number	:

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

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	11/11/2021

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Directions to “ KRISTINA E WASHBURN PA” Practice Location

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