Healthcare Provider Details

I. General information

NPI: 1053275909
Provider Name (Legal Business Name): KRISTINA PARKER PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA QUEZADA PPS

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 S JOHNSON AVE
EL CAJON CA
92020-5811
US

IV. Provider business mailing address

6416 FRIARS RD UNIT 117
SAN DIEGO CA
92108-5003
US

V. Phone/Fax

Practice location:
  • Phone: 619-402-0082
  • Fax:
Mailing address:
  • Phone: 619-402-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250307194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: