Healthcare Provider Details

I. General information

NPI: 1164952503
Provider Name (Legal Business Name): CHRISTINE KENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GARDEN VIEW CT STE 101
ENCINITAS CA
92024-2478
US

IV. Provider business mailing address

4862 PESCADERO AVE
SAN DIEGO CA
92107-3415
US

V. Phone/Fax

Practice location:
  • Phone: 760-274-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95111057
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number95111057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: