Provider Demographics
NPI:1720138662
Name:GREEN, KRISTI (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3090
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-3090
Mailing Address - Country:US
Mailing Address - Phone:209-632-2213
Mailing Address - Fax:209-632-3781
Practice Address - Street 1:1000 DELBON AVE STE 7
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2008
Practice Address - Country:US
Practice Address - Phone:209-632-2213
Practice Address - Fax:209-632-3781
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1742237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist