Provider Demographics
NPI:1942377478
Name:RETZLAFF, ANNE KRISTIN (PHD, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:KRISTIN
Last Name:RETZLAFF
Suffix:
Gender:F
Credentials:PHD, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 PORT CHICAGO HWY UNIT 5132
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1105
Mailing Address - Country:US
Mailing Address - Phone:925-609-9800
Mailing Address - Fax:925-609-7800
Practice Address - Street 1:395 TAYLOR BLVD STE 115
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2298
Practice Address - Country:US
Practice Address - Phone:925-609-9800
Practice Address - Fax:925-609-7800
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14813103TC0700X
CA95005241363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical