Provider Demographics
NPI:1891408043
Name:CRISTINA TOBON-CHUNG FNP A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CRISTINA TOBON-CHUNG FNP A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:CRISTINA TOBON-CHUNG FNP A PROFESSIONAL MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBON-CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-410-9554
Mailing Address - Street 1:7227 BROADWAY STE 402
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1505
Mailing Address - Country:US
Mailing Address - Phone:888-628-6680
Mailing Address - Fax:619-567-3500
Practice Address - Street 1:7227 BROADWAY STE 402
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1505
Practice Address - Country:US
Practice Address - Phone:888-628-6680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty