Provider Demographics
NPI:1649336819
Name:CRISTOFANI, GARY JOSEPH (CATS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JOSEPH
Last Name:CRISTOFANI
Suffix:
Gender:M
Credentials:CATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 CIVIC CT
Mailing Address - Street 2:RUBICON PROGRAMS
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5290
Mailing Address - Country:US
Mailing Address - Phone:925-265-6661
Mailing Address - Fax:925-689-7436
Practice Address - Street 1:1470 CIVIC COURT
Practice Address - Street 2:SUITE 111
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-3977
Practice Address - Country:US
Practice Address - Phone:925-265-6661
Practice Address - Fax:925-689-7436
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970139 1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACASE MANAGEROtherCARE COORDINATOR