Healthcare Provider Details

I. General information

NPI: 1669995742
Provider Name (Legal Business Name): CHRISTINA RANDLE BS,CTRS,CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA WEBSTER BS,CTRS,CBIS

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 LILY AVE
UPLAND CA
91784-7997
US

IV. Provider business mailing address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 909-931-5253
  • Fax:
Mailing address:
  • Phone: 562-385-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: