Provider Demographics
NPI:1811310451
Name:BAXTER, CHRISTIN (LPT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E G ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5407
Mailing Address - Country:US
Mailing Address - Phone:909-471-6630
Mailing Address - Fax:
Practice Address - Street 1:508 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3012
Practice Address - Country:US
Practice Address - Phone:626-332-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT31627167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician