Provider Demographics
NPI:1992268445
Name:ROBBINS, KRISTEN (LAC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TEN
Other - Middle Name:
Other - Last Name:KAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1239 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-1505
Mailing Address - Country:US
Mailing Address - Phone:510-575-1919
Mailing Address - Fax:
Practice Address - Street 1:431 30TH ST # 210D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3307
Practice Address - Country:US
Practice Address - Phone:510-338-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15115171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist