Provider Demographics
NPI:1558758755
Name:HART, KRISTINA M (DO)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FOLSOM BLVD STE 2100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5266
Mailing Address - Country:US
Mailing Address - Phone:916-374-3588
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD STE 2100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5266
Practice Address - Country:US
Practice Address - Phone:916-374-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO2033792084N0400X
CA20A159812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology