Provider Demographics
NPI:1730106808
Name:SAKET, KRISTINE H (PHD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:H
Last Name:SAKET
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:1550 HOTEL CIRCLE NORTH
Practice Address - Street 2:STE 270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2908
Practice Address - Country:US
Practice Address - Phone:619-692-1581
Practice Address - Fax:619-528-4625
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN
CAWCP20793AMedicare PIN