Provider Demographics
NPI:1225821960
Name:VEGA, KRISTINE (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:MAE
Other - Last Name:INOCENCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:589 SEABRIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4906
Mailing Address - Country:US
Mailing Address - Phone:786-907-2842
Mailing Address - Fax:
Practice Address - Street 1:589 SEABRIGHT CIR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4906
Practice Address - Country:US
Practice Address - Phone:786-907-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035221363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty