Provider Demographics
NPI:1558054049
Name:GWINN, CRIS
Entity Type:Individual
Prefix:
First Name:CRIS
Middle Name:
Last Name:GWINN
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 1:44750 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4043
Mailing Address - Country:US
Mailing Address - Phone:503-442-7286
Mailing Address - Fax:
Practice Address - Street 1:473 E. CARNEGIE DRIVE
Practice Address - Street 2:200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-277-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician