Healthcare Provider Details

I. General information

NPI: 1013524974
Provider Name (Legal Business Name): KRISTIN ANNE DIONISIO IGNACIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 LOMITA BLVD STE 106
TORRANCE CA
90505-3920
US

IV. Provider business mailing address

13175 DOSS CT
GRANADA HILLS CA
91344-1117
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-8713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: