Healthcare Provider Details

I. General information

NPI: 1619982097
Provider Name (Legal Business Name): CHRISTIANE GEORGE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL AVE
TULAROSA NM
88352-2063
US

IV. Provider business mailing address

111 CENTRAL AVE
TULAROSA NM
88352-2063
US

V. Phone/Fax

Practice location:
  • Phone: 575-585-1250
  • Fax: 575-585-1251
Mailing address:
  • Phone: 575-585-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8208
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA125204
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: