Provider Demographics
NPI:1255531208
Name:SIMMONS, KRISTINA MARIE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HARBOR BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3453
Mailing Address - Country:US
Mailing Address - Phone:916-376-8591
Mailing Address - Fax:916-376-8595
Practice Address - Street 1:1250 HARBOR BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3453
Practice Address - Country:US
Practice Address - Phone:916-376-8591
Practice Address - Fax:916-376-8595
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator