Basic Information
| Provider Information | |||||||||
| NPI: | 1144488388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRISTALOVICH | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | SOLTIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5750 W THUNDERBIRD RD | ||||||||
| Address2: | A-100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029383205 | ||||||||
| FaxNumber: | 6029385799 | ||||||||
| Practice Location | |||||||||
| Address1: | 5750 W THUNDERBIRD RD | ||||||||
| Address2: | A-100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029383205 | ||||||||
| FaxNumber: | 6029385799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | DA2019 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.