Provider Demographics
NPI:1275637282
Name:GORDEN, CHRISTY LEE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LEE
Last Name:GORDEN
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:PO BOX 8188
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-1388
Mailing Address - Country:US
Mailing Address - Phone:909-790-5071
Mailing Address - Fax:909-790-5774
Practice Address - Street 1:33353 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2018
Practice Address - Country:US
Practice Address - Phone:909-790-7900
Practice Address - Fax:909-790-7058
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42484OtherMEDICAL BOARD OF CA