Provider Demographics
NPI:1053475095
Name:JOHNSON, KRISTINA GRACE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:GRACE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:GRACE
Other - Last Name:QUARNERI-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5755 COTTLE RD
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5755 COTTLE RD
Practice Address - Street 2:BUILDING 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3640
Practice Address - Country:US
Practice Address - Phone:408-972-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18871103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist