Provider Demographics
NPI:1063853992
Name:SCHWAGER, KRISTINA ANNE (LAC)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:ANNE
Last Name:SCHWAGER
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 1:2829 NIPOMA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1113
Mailing Address - Country:US
Mailing Address - Phone:619-252-6365
Mailing Address - Fax:
Practice Address - Street 1:427 S CEDROS AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1969
Practice Address - Country:US
Practice Address - Phone:619-252-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist