Provider Demographics
NPI:1316599061
Name:PHILLIPS, CHRISTINA (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:JIAN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:564 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:564 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5423
Practice Address - Country:US
Practice Address - Phone:619-467-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist