Provider Demographics
NPI:1013383348
Name:ITALIANO, KRISTA (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:ITALIANO
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 MILL ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1442
Mailing Address - Country:US
Mailing Address - Phone:775-386-2890
Mailing Address - Fax:
Practice Address - Street 1:890 MILL ST
Practice Address - Street 2:SUITE 205
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1442
Practice Address - Country:US
Practice Address - Phone:775-386-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16024171100000X
NV2001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist