Provider Demographics
NPI:1679614622
Name:KISTIN, NAOMI J (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:J
Last Name:KISTIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1111 STANFORD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3721
Mailing Address - Country:US
Mailing Address - Phone:505-841-4113
Mailing Address - Fax:505-841-4147
Practice Address - Street 1:1111 STANFORD DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3721
Practice Address - Country:US
Practice Address - Phone:505-841-4113
Practice Address - Fax:505-841-4147
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM95-90208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics