Healthcare Provider Details

I. General information

NPI: 1073476966
Provider Name (Legal Business Name): CHRISTINE ELIZABETH JANZEN RDH, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35597 AVOCADO ST
YUCAIPA CA
92399-3521
US

IV. Provider business mailing address

35597 AVOCADO ST
YUCAIPA CA
92399-3521
US

V. Phone/Fax

Practice location:
  • Phone: 909-894-6440
  • Fax:
Mailing address:
  • Phone: 909-894-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number95679
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number27835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: