Provider Demographics
NPI:1770021792
Name:LINES, KRISTEN (MS, RD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LINES
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 LAURETTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2423
Mailing Address - Country:US
Mailing Address - Phone:619-770-9715
Mailing Address - Fax:
Practice Address - Street 1:5548 LAURETTA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2423
Practice Address - Country:US
Practice Address - Phone:619-770-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered