Provider Demographics
NPI:1790161628
Name:ANDERSON LOGHRY, KRISTEN (DO)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ANDERSON LOGHRY
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 1:451 W GONZALES RD STE 230
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0726
Mailing Address - Country:US
Mailing Address - Phone:805-988-1443
Mailing Address - Fax:805-988-0897
Practice Address - Street 1:451 W GONZALES RD STE 230
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0726
Practice Address - Country:US
Practice Address - Phone:805-988-1443
Practice Address - Fax:805-988-0897
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15261207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine