Provider Demographics
NPI:1992833859
Name:ACAYAN, CRISTETA D
Entity Type:Individual
Prefix:
First Name:CRISTETA
Middle Name:D
Last Name:ACAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 OXFORD ST STE H
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-7117
Mailing Address - Country:US
Mailing Address - Phone:619-409-3124
Mailing Address - Fax:619-409-3113
Practice Address - Street 1:1432 LONG VIEW DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1667
Practice Address - Country:US
Practice Address - Phone:619-216-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305270363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics