Provider Demographics
NPI:1174762447
Name:SYMEONIDES, KRISTINE LEE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LEE
Last Name:SYMEONIDES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:LEE
Other - Last Name:ECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 W OCEAN BLVD
Mailing Address - Street 2:#1902
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-7939
Mailing Address - Country:US
Mailing Address - Phone:619-823-8322
Mailing Address - Fax:
Practice Address - Street 1:393 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-0001
Practice Address - Country:US
Practice Address - Phone:626-405-3224
Practice Address - Fax:626-405-2675
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3809367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered