Provider Demographics
NPI:1083101968
Name:SYRIAC, CHRISTY MABLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:MABLE
Last Name:SYRIAC
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 1:22128 INGOMAR ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5524
Mailing Address - Country:US
Mailing Address - Phone:818-429-1205
Mailing Address - Fax:
Practice Address - Street 1:14400 OLIVE VIEW DR
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1436
Practice Address - Country:US
Practice Address - Phone:818-429-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics