Provider Demographics
NPI:1427659994
Name:HART, CHRISTINA SOPHIA (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SOPHIA
Last Name:HART
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 1:508 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2331
Mailing Address - Country:US
Mailing Address - Phone:510-220-0022
Mailing Address - Fax:
Practice Address - Street 1:430 NE CEDAR ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2144
Practice Address - Country:US
Practice Address - Phone:360-851-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC202025171100000X
WAAC61104627171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist