Provider Demographics
NPI:1760687917
Name:KRESTAN, SANDRA (LAC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:KRESTAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:KRESTAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:6016 BERNHARD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1210
Mailing Address - Country:US
Mailing Address - Phone:510-237-9952
Mailing Address - Fax:
Practice Address - Street 1:46513 CHAPARRAL DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-6940
Practice Address - Country:US
Practice Address - Phone:510-573-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist