Healthcare Provider Details

I. General information

NPI: 1538616404
Provider Name (Legal Business Name): CHRISTINE DEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 REDWOOD WAY STE 210
PETALUMA CA
94954-1134
US

IV. Provider business mailing address

852 BRIDLE DR
DIAMOND BAR CA
91765-1949
US

V. Phone/Fax

Practice location:
  • Phone: 760-846-6558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: