Provider Demographics
NPI:1861626152
Name:MANDERA, CRISTINA LEIGH (LMT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:LEIGH
Last Name:MANDERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:CRISTINA
Other - Middle Name:LEIGH
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7450 S. EASTERN AVE
Mailing Address - Street 2:UNIT #1084
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:702-506-4595
Mailing Address - Fax:
Practice Address - Street 1:1911 MOUNTAIN VIEW LN
Practice Address - Street 2:SUITE 200
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2382
Practice Address - Country:US
Practice Address - Phone:503-357-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist