Provider Demographics
NPI:1821373697
Name:FIESTAS, CHRISTINE EVE (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:EVE
Last Name:FIESTAS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 LOWER CAMPUS RD
Mailing Address - Street 2:DEPARTMENT OF CSD UNIVERSITY OF HAWAI'I AT MANOA
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2313
Mailing Address - Country:US
Mailing Address - Phone:808-956-6362
Mailing Address - Fax:
Practice Address - Street 1:1410 LOWER CAMPUS RD
Practice Address - Street 2:DEPARTMENT OF CSD UNIVERSITY OF HAWAI'I AT MANOA
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2313
Practice Address - Country:US
Practice Address - Phone:808-956-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist