Provider Demographics
NPI:1376540575
Name:FRITZ, CHRISTINE EVELYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:EVELYN
Last Name:FRITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE #204
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3107
Mailing Address - Country:US
Mailing Address - Phone:949-458-2026
Mailing Address - Fax:949-273-8053
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:SUITE #204
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3107
Practice Address - Country:US
Practice Address - Phone:949-458-2026
Practice Address - Fax:949-273-8053
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15579363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP63276Medicare UPIN
CAWPA15579AMedicare ID - Type Unspecified