Healthcare Provider Details

I. General information

NPI: 1356387518
Provider Name (Legal Business Name): CHRISTI S. BOURNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19646 N 27TH AVE STE 407
PHOENIX AZ
85027-4028
US

IV. Provider business mailing address

19646 N 27TH AVE STE 407
PHOENIX AZ
85027-4028
US

V. Phone/Fax

Practice location:
  • Phone: 602-374-3440
  • Fax: 602-374-3441
Mailing address:
  • Phone: 602-374-3440
  • Fax: 602-374-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19443
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: