Active NPI
Tasia Kristich
- Addiction (Substance Use Disorder) Counselor
- San Pedro, CA
National Provider Identifier
1235852609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- R1479120822
- Practice address
- 2033 S Crescent Ave
San Pedro, CA 90731-5512 - Phone
- (310) 519-8723
- NPI assigned
- Sep 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R1479120822 | CA | Primary |
Addresses
Primary practice location
2033 S Crescent Ave
San Pedro, CA 90731-5512
Mailing address
2033 S Crescent Ave
San Pedro, CA 90731-5512
Phone (310) 519-8723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1479120822 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663718400000",
"number": "1235852609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2033 S CRESCENT AVE",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907315512",
"telephone_number": "310-519-8723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2033 S CRESCENT AVE",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907315512",
"telephone_number": "310-519-8723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISTICH",
"first_name": "TASIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-21",
"last_updated": "2022-09-21",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "R1479120822",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.