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General NPI Number Information
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NPI Number | 1578188181
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Entity Type | Individual
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Provider Name | CHRESTIN ELISHA DPM
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Gender | Female
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 110 S ADAMS ST
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City | GLENDALE
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State | CA
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Zip | 91205-1312
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Country | US
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Telephone | 818-242-4426
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Fax |
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Provider Business Mailing Address
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Address Line | 191 S BUENA VISTA ST STE 475
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City | BURBANK
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State | CA
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Zip | 91505-4541
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Country | US
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Telephone | 818-322-0126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD-001100
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | EL6962
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5912
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License Number State | CA
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