Provider Demographics
NPI:1053314724
Name:PORCH-CURREN, CRISTINA N (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:N
Last Name:PORCH-CURREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N PONDEROSA DR
Mailing Address - Street 2:STE B111
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2379
Mailing Address - Country:US
Mailing Address - Phone:805-482-8989
Mailing Address - Fax:805-987-2855
Practice Address - Street 1:2412 N PONDEROSA DR
Practice Address - Street 2:STE B111
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2379
Practice Address - Country:US
Practice Address - Phone:805-482-8989
Practice Address - Fax:805-987-2855
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA74064AMedicare ID - Type Unspecified
CAH59666Medicare UPIN