Provider Demographics
NPI:1609168608
Name:SPELLER, CRISTAL DAWN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CRISTAL
Middle Name:DAWN
Last Name:SPELLER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:230 N MARYLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4283
Mailing Address - Country:US
Mailing Address - Phone:818-551-0464
Mailing Address - Fax:818-551-0462
Practice Address - Street 1:230 N MARYLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4283
Practice Address - Country:US
Practice Address - Phone:818-551-0464
Practice Address - Fax:818-551-0462
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA62390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine