Provider Demographics
NPI:1477182996
Name:CRESTE, ISABELLE THERESE
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:THERESE
Last Name:CRESTE
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 1:300 SHORELINE PKWY APT 308
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2289
Mailing Address - Country:US
Mailing Address - Phone:603-400-0839
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DR DEPT 304
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0304
Practice Address - Country:US
Practice Address - Phone:858-534-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program