Healthcare Provider Details

I. General information

NPI: 1255689410
Provider Name (Legal Business Name): KRISTINA BRIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD SUITE 110
HAWAIIAN GARDENS CA
90716-2603
US

IV. Provider business mailing address

21520 PIONEER BLVD SUITE 110
HAWAIIAN GARDENS CA
90716-2603
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: