Provider Demographics
NPI:1003410440
Name:CARRANZA, KRISTY (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MC LELLAN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:951 EDGEWATER BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404
Practice Address - Country:US
Practice Address - Phone:650-212-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty