Provider Demographics
NPI:1689443939
Name:VAILOLO, KRISTINA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:VAILOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISSIE
Other - Middle Name:
Other - Last Name:VAILOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 S STATE HIGHWAY 342 STE B
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-6517
Mailing Address - Country:US
Mailing Address - Phone:866-891-8474
Mailing Address - Fax:
Practice Address - Street 1:301 S STATE HIGHWAY 342 STE B
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-6517
Practice Address - Country:US
Practice Address - Phone:866-891-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No171400000XOther Service ProvidersHealth & Wellness Coach
No175L00000XOther Service ProvidersHomeopath
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist