Provider Demographics
NPI:1376554139
Name:COLLINS, CHRISTINE D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:D
Last Name:COLLINS
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 1:435 N ROXBURY DR STE 404
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5006
Mailing Address - Country:US
Mailing Address - Phone:310-273-3250
Mailing Address - Fax:310-626-4761
Practice Address - Street 1:435 N ROXBURY DR STE 404
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5006
Practice Address - Country:US
Practice Address - Phone:310-273-3250
Practice Address - Fax:866-404-2460
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078569174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG78569AMedicare ID - Type UnspecifiedMEDICARE NUMBER
CAG32900Medicare UPIN