Healthcare Provider Details

I. General information

NPI: 1407577588
Provider Name (Legal Business Name): HANNAH T CRISTOBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ANGELES VISTA BLVD
VIEW PARK CA
90043-1648
US

IV. Provider business mailing address

2112 SIENNA CRST
WEST COVINA CA
91790-2514
US

V. Phone/Fax

Practice location:
  • Phone: 323-810-5824
  • Fax:
Mailing address:
  • Phone: 626-756-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: