Provider Demographics
NPI:1639305469
Name:OSTERHOUT, CHRISTINE I (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:I
Last Name:OSTERHOUT
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 1:5098 FOOTHILLS BLVD
Mailing Address - Street 2:STE # 3 - 375
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6526
Mailing Address - Country:US
Mailing Address - Phone:530-220-2955
Mailing Address - Fax:
Practice Address - Street 1:4250 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4100
Practice Address - Country:US
Practice Address - Phone:530-220-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1142562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHB019AMedicare PIN