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General NPI Number Information
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NPI Number | 1821442393
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Entity Type | Individual
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Provider Name | CHRISTA DANIELLE KRELLWITZ NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1113 ALTA AVE STE 220
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City | UPLAND
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State | CA
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Zip | 91786-2803
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Country | US
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Telephone | 909-985-1908
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 ALTA AVE STE 220
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City | UPLAND
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State | CA
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Zip | 91786-2803
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Country | US
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Telephone | 909-985-1908
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | NP95004007
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License Number State | CA
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