Healthcare Provider Details

I. General information

NPI: 1386038230
Provider Name (Legal Business Name): KRISTIN OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 CALLE ORQUIDEAS
ENCINITAS CA
92024-4114
US

IV. Provider business mailing address

1518 CALLE ORQUIDEAS
ENCINITAS CA
92024-4114
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-6958
  • Fax:
Mailing address:
  • Phone: 858-692-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: