Provider Demographics
NPI:1588135883
Name:HODGE, CRISTINA RENEE
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:RENEE
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23512 DAISY TRL
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2009
Mailing Address - Country:US
Mailing Address - Phone:323-810-7337
Mailing Address - Fax:
Practice Address - Street 1:19634 VENTURA BLVD STE 212
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2984
Practice Address - Country:US
Practice Address - Phone:818-758-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist