Provider Demographics
NPI:1407097041
Name:AVALOS, CHRISTINA (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 E. TELEGRAPH ROAD
Mailing Address - Street 2:SUITE, BUILDING A
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670
Mailing Address - Country:US
Mailing Address - Phone:562-949-8455
Mailing Address - Fax:562-949-4807
Practice Address - Street 1:11721 E. TELEGRAPH ROAD
Practice Address - Street 2:SUITE, BUILDING A
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:562-949-8455
Practice Address - Fax:562-949-4807
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health