Provider Demographics
NPI:1700055712
Name:TRAUTH, KRISTINA MARIE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:TRAUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 HEACOCK ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12712 HEACOCK ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3037
Practice Address - Country:US
Practice Address - Phone:951-243-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist