Provider Demographics
NPI:1720427792
Name:RINCON-KEITH, CHRISTINA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:RINCON-KEITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:RINCON-ZAHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:113 LIELMANIS AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 LIELMANIS AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5613
Practice Address - Country:US
Practice Address - Phone:850-881-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2024-02-18
Deactivation Date:2014-11-20
Deactivation Code:
Reactivation Date:2016-11-17
Provider Licenses
StateLicense IDTaxonomies
CAPSY29950103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical