Provider Demographics
NPI:1457971491
Name:OBTERA, KRISTALYN (EDS)
Entity Type:Individual
Prefix:
First Name:KRISTALYN
Middle Name:
Last Name:OBTERA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 E J ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6115
Mailing Address - Country:US
Mailing Address - Phone:619-425-9600
Mailing Address - Fax:
Practice Address - Street 1:510 E NAPLES ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2519
Practice Address - Country:US
Practice Address - Phone:619-656-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool