Basic Information
Provider Information
NPI: 1497076194
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZUNIGA-MADRID
FirstName: CHRISTINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.A, ED.M
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GARCIA
OtherFirstName: CHRISTINA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 220 RUSKIN DR
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809102522
CountryCode: US
TelephoneNumber: 7195726100
FaxNumber: 7195726199
Practice Location
Address1: 875 W MORENO AVE
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809051731
CountryCode: US
TelephoneNumber: 7195726200
FaxNumber: 7195726299
Other Information
ProviderEnumerationDate: 06/16/2010
LastUpdateDate: 06/16/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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