Healthcare Provider Details

I. General information

NPI: 1427573286
Provider Name (Legal Business Name): CHRISTINA KALLAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

922 ELY BLVD S
PETALUMA CA
94954-4608
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number587818
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number587816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: