Provider Demographics
NPI:1902080021
Name:CUSMANO-OZOG, KRISTINA PATRICE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:PATRICE
Last Name:CUSMANO-OZOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:CUSMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:H-315
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-3161
Mailing Address - Fax:650-498-4555
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:H-315
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-3161
Practice Address - Fax:650-498-4555
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91897207SG0203X, 208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics