Healthcare Provider Details

I. General information

NPI: 1194484147
Provider Name (Legal Business Name): CRISTIAN VICTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR STE 220
LAGUNA HILLS CA
92653-1523
US

IV. Provider business mailing address

23461 S POINTE DR STE 220
LAGUNA HILLS CA
92653-1523
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1556
  • Fax: 949-951-2871
Mailing address:
  • Phone: 949-855-1556
  • Fax: 949-951-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: