Provider Demographics
NPI:1912585100
Name:IRVINE, KRYSTLE (MD)
Entity type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:
Last Name:IRVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S PATTERSON AVE STE 131
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-4025
Mailing Address - Country:US
Mailing Address - Phone:805-681-1777
Mailing Address - Fax:805-683-2705
Practice Address - Street 1:122 S PATTERSON AVE STE 131
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93111-4025
Practice Address - Country:US
Practice Address - Phone:805-681-1777
Practice Address - Fax:805-683-2705
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA181797207QG0300X, 207QG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program