MEDICARE: INGA CRISCI

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	106H00000X	Marriage & Family Therapist	AMFT138824	CA

General Provider Information

NPI Number	:	1649057639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGA CRISCI

Provider Business Mailing Address
First Line	:	4415 LONGSHORE WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-8638
Country	:	US
Telephone Number	:	760-995-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4909 MURPHY CANYON RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4349
Country	:	US
Telephone Number	:	858-922-2029
Fax Number	:

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

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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Directions to “ INGA CRISCI ” Practice Location

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