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General NPI Number Information
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NPI Number | 1376964478
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Entity Type | Individual
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Provider Name | CHRYSANTHIA KIRBY
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Gender | Female
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 1430 E COOLEY DR STE 115
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City | COLTON
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State | CA
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Zip | 92324-3936
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Country | US
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Telephone | 909-533-4889
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2161
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City | SAN BERNARDINO
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State | CA
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Zip | 92406-2161
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Country | US
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Telephone | 909-806-9890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 253889
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN268792
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License Number State | CA
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