Provider Demographics
NPI:1760036503
Name:TOSCANO, CRISTAL J
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:J
Last Name:TOSCANO
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 1:6560 MONTEZUMA RD APT 213
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2817
Mailing Address - Country:US
Mailing Address - Phone:562-239-5529
Mailing Address - Fax:
Practice Address - Street 1:321 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5128
Practice Address - Country:US
Practice Address - Phone:619-383-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3013493103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst