Healthcare Provider Details

I. General information

NPI: 1275100802
Provider Name (Legal Business Name): CHRISTAL PARKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 TOWN CENTER DR STE 116
RANCHO CUCAMONGA CA
91730-6888
US

IV. Provider business mailing address

7356 ELDERBERRY CT
FONTANA CA
92336-3185
US

V. Phone/Fax

Practice location:
  • Phone: 909-272-9005
  • Fax:
Mailing address:
  • Phone: 909-272-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: