Provider Demographics
NPI:1902561665
Name:ARCIDIACONO, KRISTA ROSE (RADT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ROSE
Last Name:ARCIDIACONO
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3163 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3537
Mailing Address - Country:US
Mailing Address - Phone:661-992-5285
Mailing Address - Fax:
Practice Address - Street 1:28765 PINE CANYON RD
Practice Address - Street 2:
Practice Address - City:LAKE HUGHES
Practice Address - State:CA
Practice Address - Zip Code:93532-1046
Practice Address - Country:US
Practice Address - Phone:661-724-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)