Provider Demographics
NPI:1205156742
Name:ANTHONY, CHRISTINA COLAIANNI (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:COLAIANNI
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1165
Mailing Address - Country:US
Mailing Address - Phone:619-981-0308
Mailing Address - Fax:
Practice Address - Street 1:775 MACKINNON CT
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1357
Practice Address - Country:US
Practice Address - Phone:619-981-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13503171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist