Healthcare Provider Details

I. General information

NPI: 1033252325
Provider Name (Legal Business Name): CHRISTINA GOLDSTEIN-CHARBONNEAU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CANYON RD STE A1
BULLHEAD CITY AZ
86442-8492
US

IV. Provider business mailing address

2500 CANYON RD STE A1
BULLHEAD CITY AZ
86442-8492
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-4499
  • Fax: 928-704-4949
Mailing address:
  • Phone: 928-704-4499
  • Fax: 928-704-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3675
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number3675
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: