Provider Demographics
NPI:1275100802
Name:PARKER, CHRISTAL (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7356 ELDERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3185
Mailing Address - Country:US
Mailing Address - Phone:909-272-9005
Mailing Address - Fax:
Practice Address - Street 1:1250 S SUNSET AVE STE 350
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3963
Practice Address - Country:US
Practice Address - Phone:909-272-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner