Provider Demographics
NPI:1154092567
Name:FRANCO, KRISTIAN (IDHS)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:FRANCO
Suffix:
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S SEASIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-7333
Mailing Address - Country:US
Mailing Address - Phone:310-694-1679
Mailing Address - Fax:
Practice Address - Street 1:1001 S SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-7333
Practice Address - Country:US
Practice Address - Phone:310-694-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1024407094OtherUNITED STATES COAST GUARD