Provider Demographics
NPI:1568514792
Name:CHRISTIAN, CATHY L (MD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:CHRISTIAN
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 1268
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-6268
Mailing Address - Country:US
Mailing Address - Phone:650-355-9116
Mailing Address - Fax:
Practice Address - Street 1:329 VIEW POINT CT
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2152
Practice Address - Country:US
Practice Address - Phone:650-355-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61244207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G612440Medicaid
00G612440Medicare ID - Type Unspecified
CA00G612440Medicaid