Provider Demographics
NPI:1801504535
Name:WESLEY, KRISTINA LYNN
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:WESLEY
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 1:2015 BALTRA PL
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3516
Mailing Address - Country:US
Mailing Address - Phone:714-641-6868
Mailing Address - Fax:
Practice Address - Street 1:2015 BALTRA PL
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3516
Practice Address - Country:US
Practice Address - Phone:714-641-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider