Provider Demographics
NPI:1093025140
Name:PRINE, KAITLIN M
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:M
Last Name:PRINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 ARMSTRONG ST
Mailing Address - Street 2:APT H13
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4973
Mailing Address - Country:US
Mailing Address - Phone:619-606-6866
Mailing Address - Fax:
Practice Address - Street 1:3132 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4421
Practice Address - Country:US
Practice Address - Phone:619-683-3100
Practice Address - Fax:619-682-4037
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator