Provider Demographics
NPI:1689947350
Name:HIRSCHFELD, KRISTINA TOUJBA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:TOUJBA
Last Name:HIRSCHFELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ANCHORAGE RD
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1623
Mailing Address - Country:US
Mailing Address - Phone:415-847-1805
Mailing Address - Fax:
Practice Address - Street 1:14 ANCHORAGE RD
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1623
Practice Address - Country:US
Practice Address - Phone:415-847-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA987299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered