Healthcare Provider Details

I. General information

NPI: 1124203310
Provider Name (Legal Business Name): CHRISTINE FLORENDO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21419 W DOVE VALLEY RD
WITTMANN AZ
85361-8412
US

IV. Provider business mailing address

21419 W DOVE VALLEY RD
WITTMANN AZ
85361-8412
US

V. Phone/Fax

Practice location:
  • Phone: 623-388-2321
  • Fax: 623-388-2204
Mailing address:
  • Phone: 623-388-2321
  • Fax: 623-388-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN027894
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: