Healthcare Provider Details

I. General information

NPI: 1679424717
Provider Name (Legal Business Name): SOPHIA CRISTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 REYNOLDS RD
RIVERSIDE CA
92503-3517
US

IV. Provider business mailing address

3950 REYNOLDS RD
RIVERSIDE CA
92503-3517
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4433
  • Fax:
Mailing address:
  • Phone: 951-358-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-LQAEKW
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: