Healthcare Provider Details

I. General information

NPI: 1306765268
Provider Name (Legal Business Name): CHRISTIAN KRUGER TINAJERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 RANCHERO LN
MERCED CA
95348-3503
US

IV. Provider business mailing address

2752 RANCHERO LN
MERCED CA
95348-3503
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax: 877-436-1488
Mailing address:
  • Phone: 209-722-4842
  • Fax: 877-436-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: