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NPI Code Detail

MEDICARE: ELMER CRISTO

MEDICARE: ELMER CRISTO
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1629335088
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELMER CRISTO
Provider Business Mailing Address
First Line : 11705 DEPUTY YAMAMOTO PL
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-4031
Country : US
Telephone Number : 323-357-6930
Fax Number :
Provider Business Practice Location Address
First Line : 11705 DEPUTY YAMAMOTO PL
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-4031
Country : US
Telephone Number : 323-357-6930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2012
Last Update Date : 04/23/2012

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Directions to “ ELMER CRISTO ” Practice Location

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