Healthcare Provider Details

I. General information

NPI: 1679111694
Provider Name (Legal Business Name): CHRISTINA NARAYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BRIGGSMORE AVE
MODESTO CA
95350-3839
US

IV. Provider business mailing address

2291 W MARCH LN STE B103
STOCKTON CA
95207-6652
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: