Healthcare Provider Details

I. General information

NPI: 1558947713
Provider Name (Legal Business Name): CHRISTINA BARONOV FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/19/2021
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 JAMES GAYNOR ST
FALLBROOK CA
92028-2642
US

IV. Provider business mailing address

1940 JAMES GAYNOR ST
FALLBROOK CA
92028-2642
US

V. Phone/Fax

Practice location:
  • Phone: 951-704-3322
  • Fax:
Mailing address:
  • Phone: 951-704-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number951016678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: