Healthcare Provider Details

I. General information

NPI: 1194752188
Provider Name (Legal Business Name): JAMES KISTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

PO BOX 80007
SALINAS CA
93912-0007
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax: 831-755-4087
Mailing address:
  • Phone: 831-755-4111
  • Fax: 831-755-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG42689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: