Provider Demographics
NPI:1932715117
Name:VISBAL, KRISTIN MARIE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:VISBAL
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 1:395 TAYLOR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2290
Mailing Address - Country:US
Mailing Address - Phone:925-608-6500
Mailing Address - Fax:
Practice Address - Street 1:395 TAYLOR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2290
Practice Address - Country:US
Practice Address - Phone:925-608-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health