Provider Demographics
NPI:1881368736
Name:CONTRERAS, KRISTA NICOLE (CPT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 E LOS ANGELES AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3373
Mailing Address - Country:US
Mailing Address - Phone:805-803-6595
Mailing Address - Fax:
Practice Address - Street 1:4214 E LOS ANGELES AVE APT 2
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3373
Practice Address - Country:US
Practice Address - Phone:805-803-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01003405374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619586930OtherBUSINESS NPI