Provider Demographics
NPI:1164881405
Name:ALL WOMEN'S REGIONAL MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:ALL WOMEN'S REGIONAL MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER MD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN-CHARBONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-704-4499
Mailing Address - Street 1:2500 CANYON RD
Mailing Address - Street 2:STE A1
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 CANYON RD
Practice Address - Street 2:STE A1
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8624
Practice Address - Country:US
Practice Address - Phone:928-704-4499
Practice Address - Fax:928-704-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP 8360261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care