Provider Demographics
NPI:1578188181
Name:ELISHA, CHRESTIN (DPM)
Entity type:Individual
Prefix:
First Name:CHRESTIN
Middle Name:
Last Name:ELISHA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 S BUENA VISTA ST STE 475
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4541
Mailing Address - Country:US
Mailing Address - Phone:818-322-0126
Mailing Address - Fax:
Practice Address - Street 1:191 S BUENA VISTA ST STE 475
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4541
Practice Address - Country:US
Practice Address - Phone:818-322-0126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-001100213ES0103X
CAEL6962390200000X
CAE5912213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program