Healthcare Provider Details

I. General information

NPI: 1639758576
Provider Name (Legal Business Name): CRHISTIAN GABRIEL TORIBIO DIONICIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR MAIL CODE #0876
LA JOLLA CA
92093-0876
US

IV. Provider business mailing address

9500 GILMAN DR MAIL CODE #0876
LA JOLLA CA
92093-0876
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number14302148-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: