Provider Demographics
NPI:1841923562
Name:KRISTEVA, DINA (NP)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:KRISTEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:KATKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1191 PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-9609
Mailing Address - Country:US
Mailing Address - Phone:559-821-6100
Mailing Address - Fax:
Practice Address - Street 1:1191 PHELPS AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9609
Practice Address - Country:US
Practice Address - Phone:559-821-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021217363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner