Provider Demographics
NPI:1083081970
Name:JARRETT, KRISTINA HEATHER (LAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:HEATHER
Last Name:JARRETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3547 CAMINO DEL RIO S STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4024
Mailing Address - Country:US
Mailing Address - Phone:619-287-4005
Mailing Address - Fax:619-287-1135
Practice Address - Street 1:3547 CAMINO DEL RIO S STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4024
Practice Address - Country:US
Practice Address - Phone:619-287-4005
Practice Address - Fax:619-287-1135
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist