Provider Demographics
NPI:1629853288
Name:TRY, CHRISTY (LE)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:TRY
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:TRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHRISTY TRY, LE
Mailing Address - Street 1:33 QUAIL CT STE 102
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5564
Mailing Address - Country:US
Mailing Address - Phone:925-297-5515
Mailing Address - Fax:925-532-1853
Practice Address - Street 1:33 QUAIL CT STE 102
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5564
Practice Address - Country:US
Practice Address - Phone:925-297-5515
Practice Address - Fax:925-532-1853
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist