Provider Demographics
NPI:1992325799
Name:MANKINS, KRISTINA MARIE (RDHAP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:MANKINS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93447-0402
Mailing Address - Country:US
Mailing Address - Phone:805-441-5499
Mailing Address - Fax:
Practice Address - Street 1:6708 N DURANT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1360
Practice Address - Country:US
Practice Address - Phone:805-441-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26249124Q00000X
CA821124Q00000X, 125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty