Provider Demographics
NPI:1689341273
Name:PRONIER, CRISTALLE (CMT)
Entity Type:Individual
Prefix:
First Name:CRISTALLE
Middle Name:
Last Name:PRONIER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CLOUDCREST
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1325
Mailing Address - Country:US
Mailing Address - Phone:949-604-7131
Mailing Address - Fax:
Practice Address - Street 1:53 CLOUDCREST
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1325
Practice Address - Country:US
Practice Address - Phone:949-604-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist