Provider Demographics
NPI:1366745242
Name:WILHITE, KRISTIN (HHP, CMT, WFNC, CNLP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WILHITE
Suffix:
Gender:F
Credentials:HHP, CMT, WFNC, CNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 GARNET AVE # 85
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3351
Mailing Address - Country:US
Mailing Address - Phone:858-774-2129
Mailing Address - Fax:
Practice Address - Street 1:2801 CAMINO DEL RIO S STE 211
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3860
Practice Address - Country:US
Practice Address - Phone:858-774-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199712447173C00000X, 174H00000X, 174400000X
133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No173C00000XOther Service ProvidersReflexologist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator
No174400000XOther Service ProvidersSpecialist