Healthcare Provider Details

I. General information

NPI: 1245000108
Provider Name (Legal Business Name): CHRISTINA SPENCER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 FREEPORT BLVD # 5
SACRAMENTO CA
95818-4347
US

IV. Provider business mailing address

3065 FREEPORT BLVD # 5
SACRAMENTO CA
95818-4347
US

V. Phone/Fax

Practice location:
  • Phone: 916-304-3076
  • Fax:
Mailing address:
  • Phone: 916-304-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: