Provider Demographics
NPI:1659661718
Name:STILLWELL, KRISTINA COALE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:COALE
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:C
Other - Last Name:COALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:402 DICKINSON ST
Mailing Address - Street 2:MPF1-140
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 DICKINSON ST
Practice Address - Street 2:MPF1-140
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6902
Practice Address - Country:US
Practice Address - Phone:858-249-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program