Provider Demographics
NPI:1831249630
Name:WATERS, CHRISTY S (MD)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:S
Last Name:WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 TORREY PINES RD UNIT B204
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3427
Mailing Address - Country:US
Mailing Address - Phone:916-300-0335
Mailing Address - Fax:
Practice Address - Street 1:43807 10TH ST W STE D
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4805
Practice Address - Country:US
Practice Address - Phone:661-575-9365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG528642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G528640Medicaid
CA00G528640Medicaid
A52374Medicare UPIN