Provider Demographics
NPI:1942815808
Name:CHRISTIAN, LIA (ACNP)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MRS
Other - First Name:LIA
Other - Middle Name:CHRISTIAN
Other - Last Name:RODRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14605 BURBANK BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-4308
Mailing Address - Country:US
Mailing Address - Phone:903-293-8187
Mailing Address - Fax:
Practice Address - Street 1:14605 BURBANK BLVD APT 109
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-4308
Practice Address - Country:US
Practice Address - Phone:903-293-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015308363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care