Provider Demographics
NPI:1821793894
Name:ATLANTIC, KRISTIN N
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:ATLANTIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 RIO SAN DIEGO DR STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1642
Mailing Address - Country:US
Mailing Address - Phone:951-387-4058
Mailing Address - Fax:
Practice Address - Street 1:24910 WASHINGTON AVE STE 303
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9284
Practice Address - Country:US
Practice Address - Phone:951-387-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist