Provider Demographics
NPI:1164044285
Name:RAGUINDIN, KIRSTIN MAREE ANDERSON (DO)
Entity type:Individual
Prefix:DR
First Name:KIRSTIN MAREE
Middle Name:ANDERSON
Last Name:RAGUINDIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 MARINE CORPS DR
Mailing Address - Street 2:
Mailing Address - City:UPPER TUMON
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1244 N MARINE CORPS DR
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4308
Practice Address - Country:US
Practice Address - Phone:671-647-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUDO-0126207Q00000X
COTL000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program