Provider Demographics
NPI:1285458943
Name:FAGNANI, CHRISTINA ANGELINA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANGELINA
Last Name:FAGNANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:FAGNANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM
Mailing Address - Street 1:302 LOMITA AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1202
Mailing Address - Country:US
Mailing Address - Phone:310-403-8462
Mailing Address - Fax:
Practice Address - Street 1:32 WOOL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5550
Practice Address - Country:US
Practice Address - Phone:310-403-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19298171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist