1134206758 NPI number — MS. CHRISTINE E ROSLUND MFT

Table of content: MS. CHRISTINE E ROSLUND MFT (NPI 1134206758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134206758 NPI number — MS. CHRISTINE E ROSLUND MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSLUND
Provider First Name:
CHRISTINE
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134206758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1915 OAKVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94602-1945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-520-2811
Provider Business Mailing Address Fax Number:
510-336-3417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 LAFAYETTE CIR STE 200
Provider Second Line Business Practice Location Address:
22248 MAIN STREET, HAYWARD CA 94541
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94549-4377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-520-2811
Provider Business Practice Location Address Fax Number:
203-724-2811
Provider Enumeration Date:
11/01/2006

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: 106H00000X , with the licence number:  MFC39100 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01674804 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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