Provider Demographics
NPI:1194050922
Name:HALLOCK, CRISTI ANNE (IDC)
Entity type:Individual
Prefix:
First Name:CRISTI
Middle Name:ANNE
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 NORMAN SCOTT RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-5387
Mailing Address - Country:US
Mailing Address - Phone:619-556-6945
Mailing Address - Fax:
Practice Address - Street 1:3292 NORMAN SCOTT RD STE 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5387
Practice Address - Country:US
Practice Address - Phone:619-556-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman