1205958626 NPI number — CHRISTINE KAY ANASTASI CERTIFIED ADDICTIONS

Table of content: CHRISTINE KAY ANASTASI CERTIFIED ADDICTIONS (NPI 1205958626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205958626 NPI number — CHRISTINE KAY ANASTASI CERTIFIED ADDICTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANASTASI
Provider First Name:
CHRISTINE
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED ADDICTIONS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANASTASI
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CMPSS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205958626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52165 AVENIDA ALVARADO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA QUINTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-832-2505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44199 MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201-3096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-832-2505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , with the licence number:  MPSS-ZYQXJI , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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