Provider Demographics
NPI:1437262813
Name:DAUPHINE, CHRISTINE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:DAUPHINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:DAUPHINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 WEST CARSON ST BOX # 25
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502
Mailing Address - Country:US
Mailing Address - Phone:310-222-6715
Mailing Address - Fax:310-782-1562
Practice Address - Street 1:1000 WEST CARSON ST BOX # 25
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502
Practice Address - Country:US
Practice Address - Phone:310-222-6715
Practice Address - Fax:310-782-1562
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76679208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA76679DMedicare PIN
CAI22483Medicare UPIN
CAWA76679CMedicare PIN
CAWA76679DMedicare PIN
CABI319ZMedicare PIN