Healthcare Provider Details

I. General information

NPI: 1558619718
Provider Name (Legal Business Name): CHRISTINA PEARCE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 PALO VERDE AVE STE 203
LONG BEACH CA
90808-4132
US

IV. Provider business mailing address

2650 ELM AVE STE 301
LONG BEACH CA
90806-1600
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-8283
  • Fax:
Mailing address:
  • Phone: 562-728-5046
  • Fax: 562-728-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number18344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: