Healthcare Provider Details

I. General information

NPI: 1437344942
Provider Name (Legal Business Name): CHRISTINA ANN BUYSSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA BUYSSE JOHNSTON

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

2025 TOURAINE LN
HALF MOON BAY CA
94019-1444
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8000
  • Fax:
Mailing address:
  • Phone: 650-725-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76197
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberG76197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: