Provider Demographics
NPI:1104087410
Name:CRISTINA
Entity type:Organization
Organization Name:CRISTINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:COLLADA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-499-9533
Mailing Address - Street 1:1210 S BASCOM AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3543
Mailing Address - Country:US
Mailing Address - Phone:408-499-9533
Mailing Address - Fax:408-261-3627
Practice Address - Street 1:1210 S BASCOM AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3543
Practice Address - Country:US
Practice Address - Phone:408-499-9533
Practice Address - Fax:408-261-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS204351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty