Provider Demographics
NPI:1285638197
Name:CHRISTENSON, CARL E (DPM)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:CHRISTENSON
Suffix:
Gender:M
Credentials:DPM
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 28915
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8915
Mailing Address - Country:US
Mailing Address - Phone:559-229-3668
Mailing Address - Fax:559-244-5866
Practice Address - Street 1:5305 N FRESNO ST STE 106A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6873
Practice Address - Country:US
Practice Address - Phone:559-229-3668
Practice Address - Fax:559-244-5866
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE38850213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38850Medicaid
480017500OtherRAILROAD MEDICARE
CA000E38850Medicare ID - Type UnspecifiedMEDICARE NUMBER
CA000E38850Medicaid