Healthcare Provider Details

I. General information

NPI: 1245474881
Provider Name (Legal Business Name): CHRISTIAN CRISTIANO M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRISTIAN CRISTIANO LAC

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 COMMODORE SLOAT DR
LOS ANGELES CA
90048-5453
US

IV. Provider business mailing address

6320 COMMODORE SLOAT DR
LOS ANGELES CA
90048-5453
US

V. Phone/Fax

Practice location:
  • Phone: 323-935-3420
  • Fax: 323-935-5933
Mailing address:
  • Phone: 323-935-3420
  • Fax: 323-935-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: