Healthcare Provider Details

I. General information

NPI: 1790817419
Provider Name (Legal Business Name): CHRISTINA FOSTER LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SILICON VALLEY BLVD
SAN JOSE CA
95138-1858
US

IV. Provider business mailing address

2705 HOMESTEAD RD APT 9
SANTA CLARA CA
95051-5338
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9000
  • Fax:
Mailing address:
  • Phone: 408-982-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberPT29283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: