Healthcare Provider Details

I. General information

NPI: 1699078923
Provider Name (Legal Business Name): KRISTIN NICOLE HEAD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25485 MEDICAL CENTER DR
MURRIETA CA
92562-6900
US

IV. Provider business mailing address

28831 TUPELO RD
MENIFEE CA
92584-7483
US

V. Phone/Fax

Practice location:
  • Phone: 951-461-9300
  • Fax:
Mailing address:
  • Phone: 858-352-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: