Provider Demographics
NPI:1366492498
Name:BURNISON, CHRISTIANE MICHELE JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIANE
Middle Name:MICHELE JEANNE
Last Name:BURNISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIANE
Other - Middle Name:JEANNE
Other - Last Name:BURNISON-HAUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:FILE 51000
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:310-423-4206
Mailing Address - Fax:310-659-3332
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:RM AC-1020
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-4206
Practice Address - Fax:310-659-3332
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG484252085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G484250Medicaid
CA00G484250OtherBLUE SHIELD
B57881Medicare UPIN
CAWG48425GMedicare PIN