Healthcare Provider Details

I. General information

NPI: 1437375938
Provider Name (Legal Business Name): KRISTINE FLYNN MPH, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SCARLET MAPLE DR
LADERA RANCH CA
92694-0838
US

IV. Provider business mailing address

19 SCARLET MAPLE DR
LADERA RANCH CA
92694-0838
US

V. Phone/Fax

Practice location:
  • Phone: 310-709-6228
  • Fax: 310-979-4667
Mailing address:
  • Phone: 310-709-6228
  • Fax: 310-979-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: