Provider Demographics
NPI:1437375938
Name:FLYNN, KRISTINE (MPH, CHES)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SCARLET MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0838
Mailing Address - Country:US
Mailing Address - Phone:310-709-6228
Mailing Address - Fax:310-979-4667
Practice Address - Street 1:19 SCARLET MAPLE DR
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0838
Practice Address - Country:US
Practice Address - Phone:310-709-6228
Practice Address - Fax:310-979-4667
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education