1073237434 NPI number — DR. CHRISTINA SUZANA CRESS PSYD

Table of content: DR. CHRISTINA SUZANA CRESS PSYD (NPI 1073237434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073237434 NPI number — DR. CHRISTINA SUZANA CRESS PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRESS
Provider First Name:
CHRISTINA
Provider Middle Name:
SUZANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LA PENA
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
SUZANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073237434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84125-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37624 SE FURY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNOQUALMIE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98065-9680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-888-2016
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2022

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: 103TC0700X , with the licence number:  61240628 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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