Healthcare Provider Details

I. General information

NPI: 1700644507
Provider Name (Legal Business Name): KIRSTEN STRETTON PPS CREDENTIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN BAIRD PPS

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9619 CUYAMACA ST
SANTEE CA
92071-2674
US

IV. Provider business mailing address

9619 CUYAMACA ST
SANTEE CA
92071-2674
US

V. Phone/Fax

Practice location:
  • Phone: 619-258-2349
  • Fax:
Mailing address:
  • Phone: 619-258-2349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220001520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: