Provider Demographics
NPI:1669645537
Name:RADOUS, CHRISTINA L (AUD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:L
Last Name:RADOUS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:22048 N 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-4256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13934 N 59TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4168
Practice Address - Country:US
Practice Address - Phone:480-278-3220
Practice Address - Fax:623-512-4107
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA5043237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-0783428OtherTAX-ID