Provider Demographics
NPI:1942400148
Name:LAPORTE, KRISTIN J (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9940 TALBERT AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-5606
Mailing Address - Fax:714-378-5621
Practice Address - Street 1:9940 TALBERT AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5606
Practice Address - Fax:714-378-5621
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066403207V00000X
CAA112246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14417Medicare UPIN