Healthcare Provider Details

I. General information

NPI: 1912585100
Provider Name (Legal Business Name): KRYSTLE IRVINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S PATTERSON AVE STE 131
GOLETA CA
93111-4025
US

IV. Provider business mailing address

122 S PATTERSON AVE STE 131
GOLETA CA
93111-4025
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-1777
  • Fax: 805-683-2705
Mailing address:
  • Phone: 805-681-1777
  • Fax: 805-683-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA181797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: