Provider Demographics
NPI:1184146631
Name:CRISTOBAL, EVA ISLA (RN, MSN,AGNP-C)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:ISLA
Last Name:CRISTOBAL
Suffix:
Gender:F
Credentials:RN, MSN,AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 E PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6081
Mailing Address - Country:US
Mailing Address - Phone:626-914-2848
Mailing Address - Fax:
Practice Address - Street 1:542 E PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6081
Practice Address - Country:US
Practice Address - Phone:626-914-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006511363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care