Provider Demographics
NPI:1639478811
Name:DEIS, CRISTINA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELIZABETH
Last Name:DEIS
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 1:2835 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7404
Mailing Address - Country:US
Mailing Address - Phone:619-474-5567
Mailing Address - Fax:
Practice Address - Street 1:2835 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7404
Practice Address - Country:US
Practice Address - Phone:619-474-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine