Provider Demographics
NPI:1447595186
Name:BARISDALE, KRISTIE LISA (LAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:LISA
Last Name:BARISDALE
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 1:8201 4TH ST. STE B
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-746-9248
Mailing Address - Fax:
Practice Address - Street 1:8201 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3728
Practice Address - Country:US
Practice Address - Phone:562-746-9248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14480171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist