Provider Demographics
NPI:1932386265
Name:ANUNCIADO, CRISAMAR JAVELLANA (NP)
Entity Type:Individual
Prefix:MRS
First Name:CRISAMAR
Middle Name:JAVELLANA
Last Name:ANUNCIADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:751 MEDICAL CENTER COURT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6617
Mailing Address - Country:US
Mailing Address - Phone:619-502-5946
Mailing Address - Fax:619-502-5965
Practice Address - Street 1:751 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6617
Practice Address - Country:US
Practice Address - Phone:619-502-5946
Practice Address - Fax:619-502-5965
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily