Provider Demographics
NPI:1093206195
Name:AUSTIN, KRISTA GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:GAIL
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 SANTA BARTOLA
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1504
Mailing Address - Country:US
Mailing Address - Phone:858-449-6663
Mailing Address - Fax:
Practice Address - Street 1:436 SANTA BARTOLA
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1504
Practice Address - Country:US
Practice Address - Phone:858-449-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator