Healthcare Provider Details

I. General information

NPI: 1275029696
Provider Name (Legal Business Name): CHRISTINA JEAN MEADOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 E DYER RD STE 135
SANTA ANA CA
92705-5643
US

IV. Provider business mailing address

134 E LA VETA AVE
ORANGE CA
92866-1908
US

V. Phone/Fax

Practice location:
  • Phone: 714-659-6395
  • Fax: 714-659-6379
Mailing address:
  • Phone: 714-290-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number90255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: