Healthcare Provider Details

I. General information

NPI: 1710674510
Provider Name (Legal Business Name): ERIC ADRIAN CRISTOBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MERCY AVE STE 301
MERCED CA
95340-8367
US

IV. Provider business mailing address

315 MERCY AVE STE 301
MERCED CA
95340-8367
US

V. Phone/Fax

Practice location:
  • Phone: 209-626-8097
  • Fax:
Mailing address:
  • Phone: 209-564-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA205117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: