Healthcare Provider Details

I. General information

NPI: 1174279921
Provider Name (Legal Business Name): CHRISTINE GO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PACKSADDLE LN
WALNUT CA
91789-4220
US

IV. Provider business mailing address

735 PACKSADDLE LN
WALNUT CA
91789-4220
US

V. Phone/Fax

Practice location:
  • Phone: 626-362-7503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95205880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95023859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: