Provider Demographics
NPI:1730176785
Name:ORTIZ, KRISTINE LYNN (NP)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:LYNN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LYNN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7901 FROST ST
Mailing Address - Street 2:SHARP MEMORIAL HOSPITAL CARDIAC TRANSPLANT DEPARTMENT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2701
Mailing Address - Country:US
Mailing Address - Phone:858-939-3400
Mailing Address - Fax:858-939-4547
Practice Address - Street 1:7901 FROST ST
Practice Address - Street 2:SHARP MEMORIAL HOSPITAL CARDIAC TRANSPLANT DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2701
Practice Address - Country:US
Practice Address - Phone:858-939-3400
Practice Address - Fax:858-939-4547
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15810363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health