Provider Demographics
NPI:1386179455
Name:MOTLAGH, KRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:MOTLAGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 MEADOW LARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 MEADOW LARK DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2711
Practice Address - Country:US
Practice Address - Phone:858-694-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist