Healthcare Provider Details

I. General information

NPI: 1083255715
Provider Name (Legal Business Name): KRISHTINA LONTOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date: 07/07/2026
Reactivation Date: 08/18/2026

III. Provider practice location address

100 STONEHOUSE CT
ROSEVILLE CA
95678-1904
US

IV. Provider business mailing address

100 STONEHOUSE CT
ROSEVILLE CA
95678-1904
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: