Healthcare Provider Details

I. General information

NPI: 1629795778
Provider Name (Legal Business Name): KRISTEN DIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN CORSARO

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CEDAR RD
VISTA CA
92083-5102
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-901-5040
  • Fax:
Mailing address:
  • Phone: 760-901-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: