Healthcare Provider Details

I. General information

NPI: 1457856734
Provider Name (Legal Business Name): CHRISTINE MARIE VAN HORN MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

IV. Provider business mailing address

2823 FRESNO ST
FRESNO CA
93721-1324
US

V. Phone/Fax

Practice location:
  • Phone: 96-454-0052
  • Fax:
Mailing address:
  • Phone: 559-459-6000
  • Fax:

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036164297
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA195809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: