Healthcare Provider Details

I. General information

NPI: 1285458943
Provider Name (Legal Business Name): CHRISTINA ANGELINA FAGNANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA FAGNANI DACM

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WOOL ST
SAN FRANCISCO CA
94110-5550
US

IV. Provider business mailing address

302 LOMITA AVE
MILLBRAE CA
94030-1202
US

V. Phone/Fax

Practice location:
  • Phone: 310-403-8462
  • Fax:
Mailing address:
  • Phone: 310-403-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: