Healthcare Provider Details

I. General information

NPI: 1992833859
Provider Name (Legal Business Name): CRISTETA D. ACAYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 LONG VIEW DR
CHULA VISTA CA
91915-1667
US

IV. Provider business mailing address

690 OXFORD ST STE H
CHULA VISTA CA
91911-7117
US

V. Phone/Fax

Practice location:
  • Phone: 619-216-9510
  • Fax:
Mailing address:
  • Phone: 619-409-3124
  • Fax: 619-409-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number305270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: