Individual
MR. KRISTOFER JOHN MAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
760 S PASADENA AVE, PASADENA, CA 91105
(626) 397-2304
Mailing address
1324 ELM PARK ST, SOUTH PASADENA, CA 91030-4504
(626) 429-3881
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95123233
CA
Other
Enumeration date
10/14/2021
Last updated
10/14/2021
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