Provider Demographics
NPI:1144035114
Name:VRONTIKIS, CHRISTINA ALEXANDRA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ALEXANDRA
Last Name:VRONTIKIS
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 1:9262 S FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-3849
Mailing Address - Country:US
Mailing Address - Phone:801-232-7580
Mailing Address - Fax:
Practice Address - Street 1:9262 S FALCON WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-3849
Practice Address - Country:US
Practice Address - Phone:801-232-7580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA001079241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered