Healthcare Provider Details

I. General information

NPI: 1841447331
Provider Name (Legal Business Name): CHRISTINE LYNN NOLAN O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27525 ENTERPRISE CIR W SUITE # 101 C
TEMECULA CA
92590-4884
US

IV. Provider business mailing address

27525 ENTERPRISE CIR W SUITE # 101 C
TEMECULA CA
92590-4884
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-7693
  • Fax: 951-676-7830
Mailing address:
  • Phone: 951-676-7693
  • Fax: 951-676-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT 3984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: