Basic Information
| Provider Information | |||||||||
| NPI: | 1700199205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANCHO | ||||||||
| FirstName: | KRISTOFFER | ||||||||
| MiddleName: | ALLAN | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5275 MARKET ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921142212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198576004 | ||||||||
| FaxNumber: | 6192637343 | ||||||||
| Practice Location | |||||||||
| Address1: | 4180 LA JOLLA VILLAGE DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662772659 | ||||||||
| FaxNumber: | 8587792511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2010 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 95020594 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.