=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912175407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINE LANGELL, M.D. A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2008
-----------------------------------------------------
Last Update Date | 05/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15195 NATIONAL AVE SUITE 206
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-358-1234
-----------------------------------------------------
Fax | 408-358-2202
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15195 NATIONAL AVE SUITE 206
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-358-1234
-----------------------------------------------------
Fax | 408-358-2202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTINE EVE LANGELL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 408-358-1234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | A069383
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------