Provider Demographics
NPI:1427362854
Name:RICHARDSON, CRISTINA G
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:G
Last Name:RICHARDSON
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 1:3259 CHATWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3628
Mailing Address - Country:US
Mailing Address - Phone:562-397-4488
Mailing Address - Fax:
Practice Address - Street 1:5572 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1302
Practice Address - Country:US
Practice Address - Phone:562-275-3542
Practice Address - Fax:562-275-3614
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist