Healthcare Provider Details

I. General information

NPI: 1659944627
Provider Name (Legal Business Name): CHRISTINA M BANASZAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA M HUNT

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FIFTH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-7199
  • Fax:
Mailing address:
  • Phone: 619-260-7199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN820537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: