Provider Demographics
NPI:1164095360
Name:RIJAL, TSHRISTI
Entity Type:Individual
Prefix:
First Name:TSHRISTI
Middle Name:
Last Name:RIJAL
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 1:5964 SYCAMORE CANYON BLVD APT 3054
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0864
Mailing Address - Country:US
Mailing Address - Phone:909-936-3970
Mailing Address - Fax:
Practice Address - Street 1:1688 N PERRIS BLVD BLDG S
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4709
Practice Address - Country:US
Practice Address - Phone:951-688-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist