Provider Demographics
NPI:1528018488
Name:HOLBERT, CHRISTINA DANIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:DANIELLE
Last Name:HOLBERT
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:PO BOX 10488
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0488
Mailing Address - Country:US
Mailing Address - Phone:909-350-4620
Mailing Address - Fax:909-854-5920
Practice Address - Street 1:7430 CHERRY AVE
Practice Address - Street 2:STE 110
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4255
Practice Address - Country:US
Practice Address - Phone:909-350-4620
Practice Address - Fax:909-854-5920
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80168207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356511349Medicaid
CA1528018488Medicaid
CA1467402149Medicaid
CABK362AMedicare PIN
CA1356511349Medicaid
CA00A801680Medicare PIN
CA1528018488Medicaid
CACV347ZMedicare PIN