Healthcare Provider Details

I. General information

NPI: 1518303924
Provider Name (Legal Business Name): CHRISTINE SHAVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 570
SANTA MONICA CA
90404-2118
US

IV. Provider business mailing address

1301 20TH ST STE 570
SANTA MONICA CA
90404-2118
US

V. Phone/Fax

Practice location:
  • Phone: 310-315-0171
  • Fax: 310-828-6647
Mailing address:
  • Phone: 310-315-0171
  • Fax: 310-828-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA147396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: