Basic Information
| Provider Information | |||||||||
| NPI: | 1477843365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUDSON | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | SOCIAL WORKER | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VIGIL | ||||||||
| OtherFirstName: | CRISTINA | ||||||||
| OtherMiddleName: | L. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2505 WHITTIER DR | ||||||||
| Address2: | |||||||||
| City: | LA CRESCENTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912143056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189571214 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12756 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188960531 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 27225 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.