Individual provider Active NPI

Karin Kristensen, PSYD

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1235162041
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY19524 Issued in CA
Practice address
3633 Camino del Rio S
Suite 204
San Diego, CA 92108-4011
Phone
(619) 281-9552
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY19524 CA Primary

Addresses

Primary practice location

3633 Camino del Rio S
Suite 204
San Diego, CA 92108-4011

Mailing address

3633 Camino del Rio S
Suite 204
San Diego, CA 92108-4011
Phone (619) 281-9552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050215001105 CA Practitioner - Clinical Psychologist 8426000670 Practice locations: San Diego, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3633 Camino del Rio S
Suite 204
San Diego, CA 92108-4048
Phone (619) 281-9552

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY19524CAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235162041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 CAMINO DEL RIO S",
            "address_2": "SUITE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084011",
            "telephone_number": "619-281-9552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 CAMINO DEL RIO S",
            "address_2": "SUITE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084011",
            "telephone_number": "619-281-9552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISTENSEN",
        "first_name": "KARIN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.