Provider Demographics
NPI:1659815694
Name:KRISTINA ANTONSON MD INC
Entity Type:Organization
Organization Name:KRISTINA ANTONSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-712-0578
Mailing Address - Street 1:1330 Q ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5705
Mailing Address - Country:US
Mailing Address - Phone:916-712-0578
Mailing Address - Fax:855-225-6311
Practice Address - Street 1:1330 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5705
Practice Address - Country:US
Practice Address - Phone:916-712-0578
Practice Address - Fax:855-225-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1138322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty