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General NPI Number Information
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NPI Number | 1942314018
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Entity Type | Individual
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Provider Name | CHRISTINA MARIE MULLICAN NP
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 4440 BROCKTON AVE SUITE 420
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City | RIVERSIDE
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State | CA
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Zip | 92501-3901
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Country | US
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Telephone | 909-684-8020
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Fax | 951-684-8090
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Provider Business Mailing Address
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Address Line | 2865 COTTAGE CT
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City | PERRIS
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State | CA
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Zip | 92571-6913
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Country | US
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Telephone | 951-684-8020
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Fax | 951-684-8090
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NP15077
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License Number State | CA
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