MEDICARE: CHRISTINE MARIA JAMES ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2000018284	CA

General Provider Information

NPI Number	:	1568967164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MARIA JAMES ATC

Provider Business Mailing Address
First Line	:	664 NICHOLSON AVE
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5730
Country	:	US
Telephone Number	:	140-848-9720
Fax Number	:

Provider Business Practice Location Address
First Line	:	664 NICHOLSON AVE
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5730
Country	:	US
Telephone Number	:	140-848-9720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	03/26/2018

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