Provider Demographics
NPI:1043374879
Name:IVES, CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:IVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5016
Mailing Address - Country:US
Mailing Address - Phone:707-463-3440
Mailing Address - Fax:707-463-3446
Practice Address - Street 1:275 S ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5016
Practice Address - Country:US
Practice Address - Phone:707-463-3440
Practice Address - Fax:707-463-3446
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71615207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A716150Medicaid
00A716150Medicare ID - Type Unspecified
H16622Medicare UPIN