Provider Demographics
NPI:1518190032
Name:SAN CRISTOBAL, PAMELA LILIANA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LILIANA
Last Name:SAN CRISTOBAL
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 1:420 N BAYSHORE BLVD APT 39
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1260
Mailing Address - Country:US
Mailing Address - Phone:408-817-0310
Mailing Address - Fax:
Practice Address - Street 1:420 N BAYSHORE BLVD APT 39
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-1260
Practice Address - Country:US
Practice Address - Phone:408-817-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program