Healthcare Provider Details

I. General information

NPI: 1376016048
Provider Name (Legal Business Name): CHRISTINE SUZANNE LUNDSTEDT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2019
Last Update Date: 08/19/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 RUFFIN RD STE 204
SAN DIEGO CA
92123-1338
US

IV. Provider business mailing address

200 S PARK RD STE 200
HOLLYWOOD FL
33021-8541
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-3630
  • Fax: 858-430-3146
Mailing address:
  • Phone: 866-986-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009138
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11009616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: