Provider Demographics
NPI:1326391004
Name:GARCIA, CRISTINA IDALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:IDALIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CRISTINA
Other - Middle Name:IDALIE
Other - Last Name:CUEVAS-FIGUEROA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6505 ROSEMEAD BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3542
Mailing Address - Country:US
Mailing Address - Phone:562-373-2007
Mailing Address - Fax:562-318-3031
Practice Address - Street 1:6505 ROSEMEAD BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3542
Practice Address - Country:US
Practice Address - Phone:562-373-2007
Practice Address - Fax:562-318-3031
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA123276OtherMEDICAL LICENSE
CAFC3547253OtherDEA