Provider Demographics
NPI:1164650669
Name:PRENDERGAST, CHRISTINA (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7704
Mailing Address - Country:US
Mailing Address - Phone:949-272-2095
Mailing Address - Fax:949-272-2096
Practice Address - Street 1:1441 AVOCADO AVE STE 301
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7704
Practice Address - Country:US
Practice Address - Phone:949-272-2095
Practice Address - Fax:949-272-2096
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A116062086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery