Healthcare Provider Details

I. General information

NPI: 1720983968
Provider Name (Legal Business Name): KRISTIN FAITH STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 VICTORIA ST
COSTA MESA CA
92627-4067
US

IV. Provider business mailing address

1515 E KATELLA AVE UNIT 4118
ANAHEIM CA
92805-6699
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-0045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: