Basic Information
| Provider Information | |||||||||
| NPI: | 1629741582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | DIANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 754 CIRCLE CT | ||||||||
| Address2: | |||||||||
| City: | SOUTH SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940802442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506895597 | ||||||||
| FaxNumber: | 6506895697 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 MAHLER RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940101604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506895597 | ||||||||
| FaxNumber: | 6506895697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2021 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.