Provider Demographics
NPI:1700199205
Name:ANCHO, KRISTOFFER ALLAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTOFFER
Middle Name:ALLAN
Last Name:ANCHO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 MARKET ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-2212
Mailing Address - Country:US
Mailing Address - Phone:619-857-6004
Mailing Address - Fax:619-263-7343
Practice Address - Street 1:4180 LA JOLLA VILLAGE DR STE 240
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1471
Practice Address - Country:US
Practice Address - Phone:866-277-2659
Practice Address - Fax:858-779-2511
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020594363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty