Provider Demographics
NPI:1326195033
Name:ENGELBRECHT, CHRISTINE BALLARD (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BALLARD
Last Name:ENGELBRECHT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:MELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:5201 NORRIS CANYON RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5410
Practice Address - Country:US
Practice Address - Phone:925-973-0605
Practice Address - Fax:925-973-0653
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480733367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00757562Medicare PIN
CACG869YMedicare PIN
CAS71893Medicare UPIN
CACG869ZMedicare PIN