Provider Demographics
NPI:1881900017
Name:HAROLDSON, KHRISTINE JOY (LAC)
Entity type:Individual
Prefix:MS
First Name:KHRISTINE
Middle Name:JOY
Last Name:HAROLDSON
Suffix:
Gender:F
Credentials:LAC
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 774
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95015-0774
Mailing Address - Country:US
Mailing Address - Phone:831-345-9774
Mailing Address - Fax:
Practice Address - Street 1:9295 E STOCKTON BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4096
Practice Address - Country:US
Practice Address - Phone:916-685-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist