Provider Demographics
NPI:1023598224
Name:WATERMAN, CRISTINA M
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:M
Last Name:WATERMAN
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 1:883 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2923
Mailing Address - Country:US
Mailing Address - Phone:949-543-6950
Mailing Address - Fax:888-403-6922
Practice Address - Street 1:883 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2923
Practice Address - Country:US
Practice Address - Phone:949-543-6950
Practice Address - Fax:888-403-6922
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician