Healthcare Provider Details

I. General information

NPI: 1467611293
Provider Name (Legal Business Name): KRISTI LYNN HUSTAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTI LYNN MARTINEZ MD

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12727 KIMBERLEY LN SUITE 303
HOUSTON TX
77024-4047
US

IV. Provider business mailing address

12727 KIMBERLEY LN SUITE 303
HOUSTON TX
77024-4047
US

V. Phone/Fax

Practice location:
  • Phone: 713-799-9999
  • Fax:
Mailing address:
  • Phone: 713-799-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberP9878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: