Provider Demographics
NPI:1225462047
Name:BRAHAM, KRISTINA ALEXIS
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ALEXIS
Last Name:BRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:ALEXIS
Other - Last Name:STAVROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3825 NORTH 24TH STREET
Mailing Address - Street 2:COMMUNITY MEDICAL SERVICES- ALPHA
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6512
Mailing Address - Country:US
Mailing Address - Phone:602-955-7997
Mailing Address - Fax:602-954-0980
Practice Address - Street 1:3825 N 24TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6512
Practice Address - Country:US
Practice Address - Phone:602-955-7997
Practice Address - Fax:602-954-0980
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator