MEDICARE: CRISTINA N. PORCH-CURREN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A74064	CA

General Provider Information

NPI Number	:	1053314724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA N. PORCH-CURREN M.D.

Provider Business Mailing Address
First Line	:	2412 N PONDEROSA DR
Second Line	:	STE B111
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2379
Country	:	US
Telephone Number	:	805-482-8989
Fax Number	:	805-987-2855

Provider Business Practice Location Address
First Line	:	2412 N PONDEROSA DR
Second Line	:	STE B111
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2379
Country	:	US
Telephone Number	:	805-482-8989
Fax Number	:	805-987-2855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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