Provider Demographics
NPI:1235378613
Name:CHRISTOPHER, CRISTINA G (PAC)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:G
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2403
Mailing Address - Country:US
Mailing Address - Phone:626-335-4041
Mailing Address - Fax:626-335-3768
Practice Address - Street 1:640 W FOOTHILL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2403
Practice Address - Country:US
Practice Address - Phone:626-335-4041
Practice Address - Fax:626-335-3768
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine