1891808846 NPI number — MRS. CRISTINA VERONICA MINCHALA MFT

Table of content: MRS. CRISTINA VERONICA MINCHALA MFT (NPI 1891808846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891808846 NPI number — MRS. CRISTINA VERONICA MINCHALA MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINCHALA
Provider First Name:
CRISTINA
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
CRISTINA
Provider Other Middle Name:
VERONICA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891808846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 E 1ST ST STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780-3335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-401-7522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E 1ST ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-810-1442
Provider Business Practice Location Address Fax Number:
800-810-1442
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 45059 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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