1881900017 NPI number — MS. KHRISTINE JOY HAROLDSON LAC

Table of content: MS. KHRISTINE JOY HAROLDSON LAC (NPI 1881900017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881900017 NPI number — MS. KHRISTINE JOY HAROLDSON LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAROLDSON
Provider First Name:
KHRISTINE
Provider Middle Name:
JOY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC
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:
1881900017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 774
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUPERTINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95015-0774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-345-9774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9295 E STOCKTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95624-4096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-685-6380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2010

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: 171100000X , with the licence number:  13193 , 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)





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