Provider Demographics
NPI:1093724791
Name:KILCLINE, CHRISTINE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DENISE
Last Name:KILCLINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:DENISE
Other - Last Name:SCHALWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:990 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6309
Mailing Address - Country:US
Mailing Address - Phone:805-544-5567
Mailing Address - Fax:805-544-3265
Practice Address - Street 1:990 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6309
Practice Address - Country:US
Practice Address - Phone:805-544-5567
Practice Address - Fax:805-544-3265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72400207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72400OtherMEDICAL LICENSE