Healthcare Provider Details

I. General information

NPI: 1447575568
Provider Name (Legal Business Name): KRISTEN MARIE ANDERSON M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE STE B2020
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

26520 CACTUS AVE STE B2020
MORENO VALLEY CA
92555-3927
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4000
  • Fax:
Mailing address:
  • Phone: 951-486-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA129812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: