Provider Demographics
NPI:1225383557
Name:STEPHENS, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 FREMONT AVE
Mailing Address - Street 2:202
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-6018
Mailing Address - Country:US
Mailing Address - Phone:626-799-7181
Mailing Address - Fax:
Practice Address - Street 1:4570 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-1422
Practice Address - Country:US
Practice Address - Phone:323-221-9174
Practice Address - Fax:323-221-7194
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376G00000XNursing Service Related ProvidersNursing Home Administrator