Basic Information
| Provider Information | |||||||||
| NPI: | 1013999226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRISTEA | ||||||||
| FirstName: | MARCELA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16455 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852116455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808891234 | ||||||||
| FaxNumber: | 4808891235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 S IDAHO RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | APACHE JUNCTION | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851196496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808891234 | ||||||||
| FaxNumber: | 4808891235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 07/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34587 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 971409 | 05 | AZ | MEDICAID |