Healthcare Provider Details

I. General information

NPI: 1790262418
Provider Name (Legal Business Name): CHRISTINA THERMIDOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ATLANTIC AVE
ALAMEDA CA
94501-1189
US

IV. Provider business mailing address

133 N SAN PEDRO RD
SAN RAFAEL CA
94903-4218
US

V. Phone/Fax

Practice location:
  • Phone: 415-948-1273
  • Fax:
Mailing address:
  • Phone: 415-948-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavioral Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: