Provider Demographics
NPI:1679051619
Name:LOWE, CHRISTINA LUISA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LUISA
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 8TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2268
Mailing Address - Country:US
Mailing Address - Phone:951-234-4208
Mailing Address - Fax:
Practice Address - Street 1:521 E 8TH ST APT A
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-2268
Practice Address - Country:US
Practice Address - Phone:951-234-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91881289C63209Medicaid