Healthcare Provider Details

I. General information

NPI: 1558622258
Provider Name (Legal Business Name): CHRISTINE BIRKNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15931 MAYBROOK ST
WESTMINSTER CA
92683-7240
US

IV. Provider business mailing address

15931 MAYBROOK ST
WESTMINSTER CA
92683-7240
US

V. Phone/Fax

Practice location:
  • Phone: 714-478-5437
  • Fax:
Mailing address:
  • Phone: 714-478-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberVN177134
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberVN177134
License Number StateCA

VIII. Authorized Official

Name: MRS. CHRISTINE ELIZABETH BIRKNER
Title or Position: LVN
Credential:
Phone: 714-478-5437