Provider Demographics
NPI:1376610329
Name:CRISTANCHO, FERNANDO (PHD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:CRISTANCHO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CIVIC DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3895
Mailing Address - Country:US
Mailing Address - Phone:925-933-6564
Mailing Address - Fax:925-933-6566
Practice Address - Street 1:1111 CIVIC DR
Practice Address - Street 2:SUITE 270
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3895
Practice Address - Country:US
Practice Address - Phone:925-933-6564
Practice Address - Fax:925-933-6566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT12158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist