Healthcare Provider Details

I. General information

NPI: 1538665971
Provider Name (Legal Business Name): KRISTEN K. BARBOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN BERRY

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 FROST ST STE 200
SAN DIEGO CA
92123-4289
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5003
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5840
  • Fax:
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberA192455
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA192455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: