Provider Demographics
NPI:1174176804
Name:PONTIGA, CHRISTIAN-JEFF MISTICA
Entity type:Individual
Prefix:
First Name:CHRISTIAN-JEFF
Middle Name:MISTICA
Last Name:PONTIGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 LOS ENCINOS ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3401
Mailing Address - Country:US
Mailing Address - Phone:650-580-8797
Mailing Address - Fax:
Practice Address - Street 1:1048 IRVINE AVE # 1056
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4602
Practice Address - Country:US
Practice Address - Phone:949-340-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA838058163W00000X
CANP95031413363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse