Healthcare Provider Details

I. General information

NPI: 1235578311
Provider Name (Legal Business Name): DAYNA DECRISTOFERI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18144 SECO ST
JAMESTOWN CA
95327-9737
US

IV. Provider business mailing address

P.O. BOX 145
SOULSBYVILLE CA
95372
US

V. Phone/Fax

Practice location:
  • Phone: 209-984-4820
  • Fax: 209-984-4825
Mailing address:
  • Phone: 209-604-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: