Healthcare Provider Details

I. General information

NPI: 1538710678
Provider Name (Legal Business Name): CHRISTINA MICHELLE ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14850 ROSCOE BLVD
PANORAMA CITY CA
91402-4618
US

IV. Provider business mailing address

15206 CALLE NARANJO
GREEN VALLEY CA
91390-1075
US

V. Phone/Fax

Practice location:
  • Phone: 818-904-3105
  • Fax: 818-904-3121
Mailing address:
  • Phone: 661-270-9698
  • Fax: 818-904-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number824919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: