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General NPI Number Information
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NPI Number | 1104087410
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Entity Type | Organization
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Legal Business Name | CRISTINA
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1210 S BASCOM AVE SUITE 122
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City | SAN JOSE
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State | CA
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Zip | 95128-3543
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Country | US
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Telephone | 408-499-9533
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Fax | 408-261-3627
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Provider Business Mailing Address
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Address Line | 1210 S BASCOM AVE SUITE 122
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City | SAN JOSE
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State | CA
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Zip | 95128-3543
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Country | US
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Telephone | 408-499-9533
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Fax | 408-261-3627
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Authorized Official
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Title or Position | LCSW
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Name | CRISTINA MERCEDES COLLADA
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Credential | LCSW
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Telephone | 408-499-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS20435
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License Number State | CA
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