Healthcare Provider Details

I. General information

NPI: 1063174506
Provider Name (Legal Business Name): CHRISTINA LATAY ELAINE TUNSTALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44443 10TH ST W
LANCASTER CA
93534-3346
US

IV. Provider business mailing address

2116 ARLINGTON AVE STE 100
LOS ANGELES CA
90018-1300
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax:
Mailing address:
  • Phone: 323-344-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1445590921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: