Provider Demographics
NPI:1992723373
Name:FLEMING, KIRSTEN (PHD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14001 HOWLAND WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2131
Mailing Address - Country:US
Mailing Address - Phone:714-731-2194
Mailing Address - Fax:714-731-0304
Practice Address - Street 1:200 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7501
Practice Address - Country:US
Practice Address - Phone:714-206-4630
Practice Address - Fax:714-731-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15190103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist