Provider Demographics
NPI:1245773589
Name:KRISTAAN, KATIE SEREY
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SEREY
Last Name:KRISTAAN
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 1:1244 NOTTING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3611
Mailing Address - Country:US
Mailing Address - Phone:408-828-4827
Mailing Address - Fax:
Practice Address - Street 1:1244 NOTTING HILL DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-3611
Practice Address - Country:US
Practice Address - Phone:408-828-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator