Provider Demographics
NPI:1124884770
Name:PATRIKIAN, CHRISTINE DANIELLE (MT-BC, NMT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DANIELLE
Last Name:PATRIKIAN
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 COUNTRY CLUB DR APT 4
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6692
Mailing Address - Country:US
Mailing Address - Phone:805-404-2431
Mailing Address - Fax:
Practice Address - Street 1:24903 PACIFIC COAST HWY STE 102
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4734
Practice Address - Country:US
Practice Address - Phone:310-310-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18561225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist