Provider Demographics
NPI:1942574967
Name:LULICH, KRISTIN MARIE (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:LULICH
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:PREISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,PMHNP-BC
Mailing Address - Street 1:4510 EXECUTIVE DR
Mailing Address - Street 2:#115
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3021
Mailing Address - Country:US
Mailing Address - Phone:619-383-6700
Mailing Address - Fax:
Practice Address - Street 1:4510 EXECUTIVE DR
Practice Address - Street 2:#115
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3021
Practice Address - Country:US
Practice Address - Phone:619-383-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA795367163W00000X
CA95002702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse