Healthcare Provider Details

I. General information

NPI: 1255643458
Provider Name (Legal Business Name): DR. KRISTIN ABAONZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 NORTH MAIN STREET
TUBA CITY AZ
86045
US

IV. Provider business mailing address

1385 W UNIVERSITY AVE UNIT 207
FLAGSTAFF AZ
86001-7139
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48526
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: