Provider Demographics
NPI:1689178659
Name:TAWIL, CHRISTINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:TAWIL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-1679
Mailing Address - Country:US
Mailing Address - Phone:626-222-6640
Mailing Address - Fax:
Practice Address - Street 1:8112 MILLIKEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7473
Practice Address - Country:US
Practice Address - Phone:909-466-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant