Provider Demographics
NPI:1578102810
Name:O'ROURKE, CRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N HARBOR BLVD STE 540
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4142
Mailing Address - Country:US
Mailing Address - Phone:714-602-1769
Mailing Address - Fax:
Practice Address - Street 1:1400 N HARBOR BLVD STE 540
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4142
Practice Address - Country:US
Practice Address - Phone:714-602-1769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant