Provider Demographics
NPI:1164635421
Name:MARTIN, CHRISTINA (LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 HEARST AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2077
Mailing Address - Country:US
Mailing Address - Phone:510-883-0383
Mailing Address - Fax:
Practice Address - Street 1:809 HEARST AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2077
Practice Address - Country:US
Practice Address - Phone:510-883-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7503171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist