Healthcare Provider Details

I. General information

NPI: 1154596161
Provider Name (Legal Business Name): KRISTA GILLIAN HARTMAN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 ROOSEVELT ST STE 100
CARLSBAD CA
92008-1688
US

IV. Provider business mailing address

25484 LAKE WOHLFORD RD SPC 180
ESCONDIDO CA
92027-5603
US

V. Phone/Fax

Practice location:
  • Phone: 360-739-0399
  • Fax:
Mailing address:
  • Phone: 360-739-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number99036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: