Provider Demographics
NPI:1659677276
Name:CHUATECO, CHRISTINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:CHUATECO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2076
Mailing Address - Country:US
Mailing Address - Phone:707-540-9112
Mailing Address - Fax:707-540-9133
Practice Address - Street 1:5901 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2076
Practice Address - Country:US
Practice Address - Phone:707-540-9112
Practice Address - Fax:707-540-9133
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist