Healthcare Provider Details

I. General information

NPI: 1578188181
Provider Name (Legal Business Name): CHRESTIN ELISHA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ADAMS ST
GLENDALE CA
91205-1312
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 475
BURBANK CA
91505-4541
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-4426
  • Fax:
Mailing address:
  • Phone: 818-322-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-001100
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberEL6962
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: