Provider Demographics
NPI:1447063896
Name:LALLAS, CHRISTINA M (BSN, RN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:LALLAS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 E ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-2111
Mailing Address - Country:US
Mailing Address - Phone:559-834-6080
Mailing Address - Fax:
Practice Address - Street 1:1111 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2002
Practice Address - Country:US
Practice Address - Phone:559-265-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95340505163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool