Provider Demographics
NPI:1609924661
Name:CSINTALAN, MIKI (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKI
Middle Name:
Last Name:CSINTALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCI STUDENT HEALTH
Mailing Address - Street 2:501 STUDENT HEALTH
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-5200
Mailing Address - Country:US
Mailing Address - Phone:949-824-5301
Mailing Address - Fax:949-824-3033
Practice Address - Street 1:UCI STUDENT HEALTH
Practice Address - Street 2:501 STUDENT HEALTH
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-5200
Practice Address - Country:US
Practice Address - Phone:949-824-5301
Practice Address - Fax:949-824-3033
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A617910Medicaid
H21155Medicare UPIN