Provider Demographics
NPI:1760751697
Name:MARCHIS-CRISAN, CRISTINA ELENA (DPM)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELENA
Last Name:MARCHIS-CRISAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:ELENA
Other - Last Name:CRISAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:984 W FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3787
Mailing Address - Country:US
Mailing Address - Phone:909-920-0884
Mailing Address - Fax:909-920-9810
Practice Address - Street 1:984 W FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3787
Practice Address - Country:US
Practice Address - Phone:909-920-0884
Practice Address - Fax:909-920-9810
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4395213EP1101X, 213ES0103X
CAE4968213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO4395OtherFL DPM LICENCE
CAE4968OtherCA DPM LICENSE
CAGH080ZOtherSO CA MEDIARE PTAN