Healthcare Provider Details

I. General information

NPI: 1578965893
Provider Name (Legal Business Name): CHRISTINE DECRISTOFARO MA, IMF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W TOWN AND COUNTRY RD
ORANGE CA
92868-4712
US

IV. Provider business mailing address

812 W TOWN AND COUNTRY RD
ORANGE CA
92868-4712
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-6494
  • Fax: 714-547-6464
Mailing address:
  • Phone: 714-547-6494
  • Fax: 714-547-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 71082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: