Healthcare Provider Details

I. General information

NPI: 1013833789
Provider Name (Legal Business Name): KRISTIINA VISBAL DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 1/2 W RIVERSIDE DR
BURBANK CA
91505-4044
US

IV. Provider business mailing address

1022 PACIFIC ST APT E
SANTA MONICA CA
90405-1443
US

V. Phone/Fax

Practice location:
  • Phone: 213-772-7967
  • Fax:
Mailing address:
  • Phone: 650-678-8516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: