Healthcare Provider Details

I. General information

NPI: 1871291856
Provider Name (Legal Business Name): CRISTINA MARIA KING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13255 SKY MEADOW WAY
OREGON HOUSE CA
95962-8033
US

IV. Provider business mailing address

PO BOX 842
OREGON HOUSE CA
95962-0842
US

V. Phone/Fax

Practice location:
  • Phone: 530-687-2864
  • Fax:
Mailing address:
  • Phone: 530-687-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: