Healthcare Provider Details

I. General information

NPI: 1144424904
Provider Name (Legal Business Name): CHRISTINE MASTER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S MAIN ST STE 100 CORDELIA KNOTT CENTER FOR WELLNESS
ORANGE CA
92868-3851
US

IV. Provider business mailing address

2360 GYPSUM CT
CHINO HILLS CA
91709-2130
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-9355
  • Fax:
Mailing address:
  • Phone: 909-597-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number264187
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number8921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: