Provider Demographics
NPI:1144698556
Name:KITLINGER, CYNTHIA (RADT I)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KITLINGER
Suffix:
Gender:F
Credentials:RADT I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 RUFFIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1875
Mailing Address - Country:US
Mailing Address - Phone:858-384-6284
Mailing Address - Fax:858-384-6453
Practice Address - Street 1:3645 RUFFIN RD. #100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1875
Practice Address - Country:US
Practice Address - Phone:858-384-6284
Practice Address - Fax:858-384-6453
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370069IN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA373781000Medicaid