Provider Demographics
NPI:1508629973
Name:CHUA-HARRIS, CHRISTINE DYAN
Entity Type:Individual
Prefix:
First Name:CHRISTINE DYAN
Middle Name:
Last Name:CHUA-HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6924 OAK SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1226
Mailing Address - Country:US
Mailing Address - Phone:916-579-9222
Mailing Address - Fax:
Practice Address - Street 1:6924 OAK SPRING WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1226
Practice Address - Country:US
Practice Address - Phone:916-579-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6067752740376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator