Healthcare Provider Details

I. General information

NPI: 1023826377
Provider Name (Legal Business Name): CHRISTA JINN CUISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 VENTURA BLVD STE 420
ENCINO CA
91436-4711
US

IV. Provider business mailing address

2783 SAVANNAH CT
CHULA VISTA CA
91914-4219
US

V. Phone/Fax

Practice location:
  • Phone: 818-927-0478
  • Fax:
Mailing address:
  • Phone: 619-974-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: