Provider Demographics
NPI:1710097720
Name:SANFORD, KRISTEN K (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:K
Last Name:SANFORD
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 1:16899 W BERNARDO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1603
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1607
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:858-521-2019
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX69640Medicaid
CAG14987Medicare UPIN
CAW20A6964BMedicare ID - Type Unspecified