Provider Demographics
NPI:1689706418
Name:ALCANTAR, CRISTINA
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:ALCANTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BROADWAY STE D
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4755
Mailing Address - Country:US
Mailing Address - Phone:209-345-3089
Mailing Address - Fax:209-250-0556
Practice Address - Street 1:200 N BROADWAY STE D
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4755
Practice Address - Country:US
Practice Address - Phone:209-345-3089
Practice Address - Fax:209-250-0556
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist