Healthcare Provider Details

I. General information

NPI: 1396238671
Provider Name (Legal Business Name): CHRISTINA KITAYO ARAKAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LAGUNA RD STE C
FULLERTON CA
92835-3637
US

IV. Provider business mailing address

101 LAGUNA RD STE C
FULLERTON CA
92835-3637
US

V. Phone/Fax

Practice location:
  • Phone: 714-888-2080
  • Fax:
Mailing address:
  • Phone: 714-888-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33937TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: