Healthcare Provider Details

I. General information

NPI: 1063892891
Provider Name (Legal Business Name): CHRISTINA STEPHANIE THABIT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-3000
  • Fax:
Mailing address:
  • Phone: 714-997-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA159766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: