Basic Information
| Provider Information | |||||||||
| NPI: | 1780097675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESCALLAR | ||||||||
| FirstName: | CRISTINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1641 N RIPON RD APT 505 | ||||||||
| Address2: | |||||||||
| City: | RIPON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953669818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144798760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4601 DALE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953569718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097355000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | A159251 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.