Provider Demographics
NPI:1831733369
Name:THUDIUM, CRISTINA MARIE
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MARIE
Last Name:THUDIUM
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 1:42485 ROUNDUP DR
Mailing Address - Street 2:
Mailing Address - City:AGUANGA
Mailing Address - State:CA
Mailing Address - Zip Code:92536-9340
Mailing Address - Country:US
Mailing Address - Phone:951-707-8945
Mailing Address - Fax:
Practice Address - Street 1:42485 ROUNDUP DR
Practice Address - Street 2:
Practice Address - City:AGUANGA
Practice Address - State:CA
Practice Address - Zip Code:92536-9340
Practice Address - Country:US
Practice Address - Phone:951-707-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC4827242OtherDRIVER LICENSE