Basic Information
| Provider Information | |||||||||
| NPI: | 1063542835 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VINDUA | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 9TH STREET | ||||||||
| Address2: | ROOM 205, MAILSTOP 2-3 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 942442020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166543482 | ||||||||
| FaxNumber: | 9166534587 | ||||||||
| Practice Location | |||||||||
| Address1: | 3102 E. HIGHLAND AVENUE | ||||||||
| Address2: | PATTON STATE HOSPITAL | ||||||||
| City: | PATTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094257679 | ||||||||
| FaxNumber: | 9094256635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 09/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 103TC0700X | PSY24489 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.