Provider Demographics
NPI:1891808846
Name:MINCHALA, CRISTINA VERONICA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:VERONICA
Last Name:MINCHALA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:CRISTINA
Other - Middle Name:VERONICA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 E 1ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3335
Mailing Address - Country:US
Mailing Address - Phone:714-401-7522
Mailing Address - Fax:
Practice Address - Street 1:515 E 1ST ST
Practice Address - Street 2:SUITE D
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3335
Practice Address - Country:US
Practice Address - Phone:800-810-1442
Practice Address - Fax:800-810-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist