Provider Demographics
NPI:1023692225
Name:MCADAMS, KRISTIAN LOLA (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:LOLA
Last Name:MCADAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 LA CANADA CREST DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1913
Mailing Address - Country:US
Mailing Address - Phone:661-313-0583
Mailing Address - Fax:
Practice Address - Street 1:1111 N BRAND BLVD STE 402
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3071
Practice Address - Country:US
Practice Address - Phone:626-317-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist