Healthcare Provider Details

I. General information

NPI: 1518346741
Provider Name (Legal Business Name): CRISTINA ANAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 MCHENRY AVE
MODESTO CA
95350-5417
US

IV. Provider business mailing address

916 MCHENRY AVE
MODESTO CA
95350-5417
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-5850
  • Fax:
Mailing address:
  • Phone: 209-550-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberASW67905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: