Provider Demographics
NPI:1508409202
Name:TRISTAO, KRISTIN OLIVIA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:OLIVIA
Last Name:TRISTAO
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 1:6700 N 1ST ST STE 138
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3956
Mailing Address - Country:US
Mailing Address - Phone:559-227-1977
Mailing Address - Fax:559-227-2698
Practice Address - Street 1:6700 N 1ST ST STE 138
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3956
Practice Address - Country:US
Practice Address - Phone:559-227-1977
Practice Address - Fax:559-272-2698
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist