Provider Demographics
NPI:1477388957
Name:CRISTERNA, GRACIELA (FNP)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:CRISTERNA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77935 CALLE TAMPICO STE 103
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2947
Mailing Address - Country:US
Mailing Address - Phone:760-790-7711
Mailing Address - Fax:
Practice Address - Street 1:77935 CALLE TAMPICO STE 103
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2947
Practice Address - Country:US
Practice Address - Phone:442-599-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily