Provider Demographics
NPI:1437746617
Name:DOSH, KRISTIN DIANA (PPS, LEP, MA, EDS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DIANA
Last Name:DOSH
Suffix:
Gender:F
Credentials:PPS, LEP, MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 ORR AND DAY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4161
Mailing Address - Country:US
Mailing Address - Phone:562-698-8121
Mailing Address - Fax:
Practice Address - Street 1:10400 ORR AND DAY RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4161
Practice Address - Country:US
Practice Address - Phone:562-698-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200049071103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4037OtherDEPARTMENT OF CONSUMER AFFAIRS