Provider Demographics
NPI:1134169782
Name:GREEN, KRISTIN STILES (ND)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:STILES
Last Name:GREEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:STILES GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:227 W JANSS RD
Mailing Address - Street 2:#135
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-373-2890
Mailing Address - Fax:805-364-5464
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:#135
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-373-2890
Practice Address - Fax:805-364-5464
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-110202D00000X
CAND 110175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine