Healthcare Provider Details

I. General information

NPI: 1891178216
Provider Name (Legal Business Name): CHRISTINE ANNE LIWANPO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3689 EUREKA WAY
REDDING CA
96001-0177
US

IV. Provider business mailing address

3689 EUREKA WAY
REDDING CA
96001-0177
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-4577
  • Fax: 530-244-4576
Mailing address:
  • Phone: 530-244-4577
  • Fax: 530-244-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: